Healthcare Provider Details

I. General information

NPI: 1780805473
Provider Name (Legal Business Name): ALI FARAHNAKIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 NC 8 AND 89 HWY N
DANBURY NC
27016-0010
US

IV. Provider business mailing address

1570 NC 8 AND 89 HWY NORTH
DANBURY NC
27016-0010
US

V. Phone/Fax

Practice location:
  • Phone: 336-593-5311
  • Fax: 336-593-5350
Mailing address:
  • Phone: 336-593-5311
  • Fax: 336-593-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number19925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: