Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25886 | WV |
N | 207N00000X | Dermatologist | A123744 | CA |
NPI | 1053553131 |
---|---|
Provider Name | Sharifeh Farasat |
First Address | Bridgeport, WV 26330-9012 |
Second Address | Bridgeport, WV 26330-9012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 23/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810027666 | (05) | WV |