Healthcare Provider Details

I. General information

NPI: 1871819086
Provider Name (Legal Business Name): FARAH TAHIR PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 ELM ST
MANCHESTER NH
03101-1308
US

IV. Provider business mailing address

1245 ELM ST
MANCHESTER NH
03101-1308
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-6629
  • Fax: 603-622-7680
Mailing address:
  • Phone: 603-668-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0767
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: