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General NPI Number Information
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NPI Number | 1962301937
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Entity Type | Individual
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Provider Name | ISABELLA FARAH IDRIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 11123 MONTGOMERY RD STE 105
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City | CINCINNATI
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State | OH
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Zip | 45249-2390
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Country | US
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Telephone | 513-342-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 4214 APPLETON ST APT 2
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City | CINCINNATI
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State | OH
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Zip | 45209-1204
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.010646RX
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License Number State | OH
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