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General NPI Number Information
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NPI Number | 1366718702
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Entity Type | Individual
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Provider Name | FARAH AHMAD-STOUT MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 1315 WALNUT ST STE 1708
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4717
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Country | US
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Telephone | 267-930-2813
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22387
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City | PHILADELPHIA
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State | PA
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Zip | 19110-2387
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Country | US
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Telephone | 267-930-2813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD464479
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License Number State | PA
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