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General NPI Number Information
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NPI Number | 1891837076
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Entity Type | Organization
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Legal Business Name | SYCAMORE INTERNAL MEDICINE AND WOMEN'S WELLNESS CENTER INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 4000 MIAMISBURG CENTERVILLE RD SUITE 207
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City | MIAMISBURG
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State | OH
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Zip | 45342-3758
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Country | US
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Telephone | 937-866-6655
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Fax | 937-866-6595
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | MIAMISBURG
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State | OH
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Zip | 45343-0270
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Country | US
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Telephone | 937-866-6655
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Fax | 937-866-6595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIDA FARHANGI
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Credential | MD
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Telephone | 937-866-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 35.092005
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-07-8961F
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License Number State | OH
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