Healthcare Provider Details

I. General information

NPI: 1205271210
Provider Name (Legal Business Name): FARZANA TARIQ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXCELA HEALTH DR STE 203B
LATROBE PA
15650-9001
US

IV. Provider business mailing address

100 EXCELA HEALTH DR STE 203B
LATROBE PA
15650-9001
US

V. Phone/Fax

Practice location:
  • Phone: 724-532-0866
  • Fax: 724-532-0869
Mailing address:
  • Phone: 724-532-0866
  • Fax: 724-532-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101271396
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD491509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: