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1871533653

NPI Code Detail

MEDICARE: DR. FARID GHARAGOZLOO M.D.

MEDICARE: DR. FARID GHARAGOZLOO 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD20785	DC
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME118239	FL
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	20565	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3123363	OTHER	DC	MAMSI HEALTH & LIFE
2	5318172	OTHER	AZ	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	J449-0001	OTHER	DC	CAREFIRST BLUESHIELD
6	53273804	OTHER	MD	CAREFIRST BLUESHEILD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871533653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARID GHARAGOZLOO M.D.

Provider Business Mailing Address
First Line	:	5092 ISLEWORTH COUNTRY CLUB DR
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8920
Country	:	US
Telephone Number	:	202-841-7304
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 LAKE NONA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7982
Country	:	US
Telephone Number	:	407-747-1899
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/16/2022

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Directions to “ DR. FARID GHARAGOZLOO M.D.” Practice Location

Language	Start Address	Practice Location

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