Healthcare Provider Details

I. General information

NPI: 1285648329
Provider Name (Legal Business Name): SAMIR F FARAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 RIDGE PIKE
EAGLEVILLE PA
19403-1411
US

IV. Provider business mailing address

PO BOX 432
GWYNEDD VALLEY PA
19437-0432
US

V. Phone/Fax

Practice location:
  • Phone: 610-917-2200
  • Fax: 610-917-2360
Mailing address:
  • Phone: 610-917-2200
  • Fax: 610-917-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD039341L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: