1255547220 NPI number — AHMED FARRAG MD

Table of content: AHMED FARRAG MD (NPI 1255547220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255547220 NPI number — AHMED FARRAG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRAG
Provider First Name:
AHMED
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255547220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 ALHAMBRA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94553-3156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-313-7900
Provider Business Mailing Address Fax Number:
925-646-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W HIGHWAY 22
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-381-3000
Provider Business Practice Location Address Fax Number:
847-382-4755
Provider Enumeration Date:
05/15/2007

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: 207Q00000X , with the licence number:  C1318105 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FARRAAHM . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com