MEDICARE: DR. MOHAMMAD TAHIR FAROOQ M.D.

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	204R00000X	Electrodiagnostic Medicine Physician	MD054264L	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	MD054264L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659302123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD TAHIR FAROOQ M.D.

Provider Business Mailing Address
First Line	:	908 RAINBOW DR
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-2333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 FRONT ST STE 280
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2891
Country	:	US
Telephone Number	:	484-351-8459
Fax Number	:	484-351-8810

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/29/2021

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