Provider Demographics
NPI:1548248388
Name:JAMALI, FARHAD (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:JAMALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0569
Mailing Address - Country:US
Mailing Address - Phone:301-805-0006
Mailing Address - Fax:301-805-5757
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:SUITE 308
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-805-0006
Practice Address - Fax:301-805-5757
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402906200Medicaid
MDH95687Medicare UPIN
MD402906200Medicaid
DCP00396475Medicare PIN