Healthcare Provider Details

I. General information

NPI: 1073962270
Provider Name (Legal Business Name): FARZAD SALEH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 OXON HILL RD STE 305
OXON HILL MD
20745-3168
US

IV. Provider business mailing address

106 FIESTA DR
STEPHENSON VA
22656-1876
US

V. Phone/Fax

Practice location:
  • Phone: 301-567-5005
  • Fax: 301-839-5677
Mailing address:
  • Phone: 240-285-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01685
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: