MEDICARE: TANIA FAKHERI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C0006523	MD

General Provider Information

NPI Number	:	1063931210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA FAKHERI

Provider Business Mailing Address
First Line	:	9199 REISTERSTOWN RD STE
Second Line	:	101B
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9199 REISTERSTOWN RD STE 101B
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4513
Country	:	US
Telephone Number	:	443-898-8160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

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Directions to “ TANIA FAKHERI ” Practice Location

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