Healthcare Provider Details

I. General information

NPI: 1922043934
Provider Name (Legal Business Name): HUSAM HANNA FARAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OLD ROLLINSFORD RD BLDG B
DOVER NH
03820-2807
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-4265
  • Fax:
Mailing address:
  • Phone: 617-726-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14541
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14541
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: