Healthcare Provider Details

I. General information

NPI: 1447379698
Provider Name (Legal Business Name): FARID J LOUIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

QUEST DIAGNOSTIC INC 415 MASSACHUSETTS AVENUE
CAMBRIDGE MA
02139
US

IV. Provider business mailing address

247 CONCORD AVE
LEXINGTON MA
02421-8207
US

V. Phone/Fax

Practice location:
  • Phone: 617-547-8900
  • Fax:
Mailing address:
  • Phone: 617-547-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number36544
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: