Basic Information
| Provider Information | |||||||||
| NPI: | 1891722419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAROOQ | ||||||||
| FirstName: | FAHEEM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 GROVE STREET | ||||||||
| Address2: | STE 305 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020383156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085285392 | ||||||||
| FaxNumber: | 5085412420 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDWAY ROAD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087736288 | ||||||||
| FaxNumber: | 5084825430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41365 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 41365 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2055821 | 05 | MA | MEDICAID |