1629209176 NPI number — FARSHAD FOROUZANDEH M.D., PH.D.

Table of content: FARSHAD FOROUZANDEH M.D., PH.D. (NPI 1629209176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629209176 NPI number — FARSHAD FOROUZANDEH M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOROUZANDEH
Provider First Name:
FARSHAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629209176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 WOODRUFF CIR
Provider Second Line Business Mailing Address:
WMB 308
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30322-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-727-4724
Provider Business Mailing Address Fax Number:
404-712-8335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 POWERS BLVD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-5461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-882-0075
Provider Business Practice Location Address Fax Number:
440-882-0080
Provider Enumeration Date:
07/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  PERMIT#005402 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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