Healthcare Provider Details

I. General information

NPI: 1609071661
Provider Name (Legal Business Name): FARAZ MASOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16021 KAIROS RD STE A
SOUTH CHESTERFIELD VA
23834-5208
US

IV. Provider business mailing address

16021 KAIROS RD STE A
SOUTH CHESTERFIELD VA
23834-5208
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-3821
  • Fax: 804-526-6065
Mailing address:
  • Phone: 804-526-3821
  • Fax: 804-526-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25751
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101255626
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61245176
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101255626
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number311465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: