Healthcare Provider Details

I. General information

NPI: 1114312774
Provider Name (Legal Business Name): ABTIN FARAHMAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

IV. Provider business mailing address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7700
  • Fax:
Mailing address:
  • Phone: 207-396-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA144791
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPENDING
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: