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General NPI Number Information
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NPI Number | 1770558496
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Entity Type | Individual
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Provider Name | FARID ABDULREHMAN THANAWALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 919 CONFERENCE DR STE 4
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-1924
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Country | US
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Telephone | 615-788-9324
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Fax |
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Provider Business Mailing Address
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Address Line | 919 CONFERENCE DR SUITE #4, BOX 167
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-1924
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Country | US
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Telephone | 615-788-9324
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 217086
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24890
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 56250
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 04-39312
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD18855
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License Number State | HI
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Taxonomy #6
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 217086
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 24890
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License Number State | NE
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Taxonomy #8
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 54593
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License Number State | TN
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