Healthcare Provider Details

I. General information

NPI: 1689751620
Provider Name (Legal Business Name): ASHRAF FARID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MAIN ST STE 6
STURBRIDGE MA
01566-1284
US

IV. Provider business mailing address

48 MAIN ST STE 6
STURBRIDGE MA
01566-1284
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-9111
  • Fax: 508-347-7111
Mailing address:
  • Phone: 508-347-9111
  • Fax: 508-347-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number047639
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD11073
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number212790
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number047639
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD11073
License Number StateRI
# 6
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number212790
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: