1720053432 NPI number — DR. FARIDA N AWAN M.D.

Table of content: DR. FARIDA N AWAN M.D. (NPI 1720053432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720053432 NPI number — DR. FARIDA N AWAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWAN
Provider First Name:
FARIDA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1720053432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 82229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36689-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-382-1878
Provider Business Mailing Address Fax Number:
888-229-2558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 AIRPORT BLVD STE B110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-6775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-382-1878
Provider Business Practice Location Address Fax Number:
251-706-2150
Provider Enumeration Date:
02/17/2006

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: 2080A0000X , with the licence number:  00016971 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD.16971 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009942866 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".