Healthcare Provider Details

I. General information

NPI: 1073558151
Provider Name (Legal Business Name): TRUMAN FARAH SOUDAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 WALTHAM WOODS RD STE 101
PARKVILLE MD
21234-2402
US

IV. Provider business mailing address

8813 WALTHAM WOODS RD STE 101 MEDICAL PRACTICE OF OB GYN
PARKVILLE MD
21234-2402
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-8690
  • Fax: 410-661-4416
Mailing address:
  • Phone: 410-661-8690
  • Fax: 410-661-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0018966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: