Healthcare Provider Details

I. General information

NPI: 1215622212
Provider Name (Legal Business Name): GHAZAL FARAJZADEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST # N5W70A
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

6540 SW 135TH DR
PINECREST FL
33156-7074
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6960
  • Fax:
Mailing address:
  • Phone: 305-801-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0107190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: