Healthcare Provider Details

I. General information

NPI: 1700880598
Provider Name (Legal Business Name): FAROOQ P AGHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE STE 150
ALBUQUERQUE NM
87109-5888
US

IV. Provider business mailing address

4411 THE 25 WAY NE STE 150
ALBUQUERQUE NM
87109-5888
US

V. Phone/Fax

Practice location:
  • Phone: 505-332-6900
  • Fax: 505-332-6921
Mailing address:
  • Phone: 505-332-6900
  • Fax: 505-332-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number98-3
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: