Healthcare Provider Details

I. General information

NPI: 1295724888
Provider Name (Legal Business Name): FAROOK A. SHAIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 CASTLE PL SUITE 3C
FALLS CHURCH VA
22044-1905
US

IV. Provider business mailing address

6305 CASTLE PLACE SUITE 3C
FALLS CHURCH VA
22044-1905
US

V. Phone/Fax

Practice location:
  • Phone: 703-241-2408
  • Fax: 703-241-2070
Mailing address:
  • Phone: 703-241-2408
  • Fax: 703-241-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101040532
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: