Healthcare Provider Details

I. General information

NPI: 1508221367
Provider Name (Legal Business Name): MOHAMMAD FAROOQ USMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

IV. Provider business mailing address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8900
  • Fax:
Mailing address:
  • Phone: 207-662-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD28246
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: