Healthcare Provider Details

I. General information

NPI: 1326201229
Provider Name (Legal Business Name): FARZANEH SAYEDIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STADIUM DR
MORGANTOWN WV
26506-7911
US

IV. Provider business mailing address

101 STADIUM DR
MORGANTOWN WV
26506-7911
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-9152
  • Fax:
Mailing address:
  • Phone: 248-977-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number24671
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number4301091825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: