MEDICARE: MARZAN ALIFARUQUEY MD

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	207Q00000X	Family Medicine Physician	2021-02638	NC

General Provider Information

NPI Number	:	1780150912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARZAN ALIFARUQUEY MD

Provider Business Mailing Address
First Line	:	111 N WASHINGTON AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18503-1828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 BRIGHTON 7TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6415
Country	:	US
Telephone Number	:	347-397-3751
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	01/14/2022

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