Healthcare Provider Details

I. General information

NPI: 1629386735
Provider Name (Legal Business Name): FARSHAD ADIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FARSHAD ADIB HADJI BAGHERI M.D.

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 MADISON PARK DR
GLEN BURNIE MD
21061-6355
US

IV. Provider business mailing address

1413 MADISON PARK DR
GLEN BURNIE MD
21061-6355
US

V. Phone/Fax

Practice location:
  • Phone: 410-691-3571
  • Fax:
Mailing address:
  • Phone: 410-691-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD77135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: