Healthcare Provider Details

I. General information

NPI: 1083234868
Provider Name (Legal Business Name): IBRAHIM FARAH MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 GELBRAY AVE
COLUMBUS OH
43204-1881
US

IV. Provider business mailing address

1426 GELBRAY AVE
COLUMBUS OH
43204-1881
US

V. Phone/Fax

Practice location:
  • Phone: 614-664-9201
  • Fax:
Mailing address:
  • Phone: 614-664-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: