Healthcare Provider Details

I. General information

NPI: 1629025630
Provider Name (Legal Business Name): MAEN J. FARHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST SUITE 655
BALTIMORE MD
21218-2867
US

IV. Provider business mailing address

3333 N CALVERT ST SUITE 655
BALTIMORE MD
21218-2867
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-8720
  • Fax: 410-321-8723
Mailing address:
  • Phone: 410-321-8720
  • Fax: 410-321-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD29771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: