Healthcare Provider Details

I. General information

NPI: 1710288659
Provider Name (Legal Business Name): FD FARAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

PO BOX 335
CANTON MA
02021-0335
US

V. Phone/Fax

Practice location:
  • Phone: 781-856-7000
  • Fax: 617-591-4360
Mailing address:
  • Phone: 781-856-7000
  • Fax: 617-591-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number230152
License Number StateMA

VIII. Authorized Official

Name: DR. FARAH RAFIK DAWOOD FARAH
Title or Position: OWNER
Credential: M.D.
Phone: 781-856-7000