Healthcare Provider Details

I. General information

NPI: 1821520131
Provider Name (Legal Business Name): AMINA FAROOQ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST # S2A19
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST # S2A19
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 631-473-1320
  • Fax:
Mailing address:
  • Phone: 404-756-1368
  • Fax: 404-756-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD98775
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD98775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: