Provider Demographics
NPI:1215968193
Name:IQBAL, FARZANA SHARMIN (MD)
Entity type:Individual
Prefix:
First Name:FARZANA
Middle Name:SHARMIN
Last Name:IQBAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FARZANA
Other - Middle Name:
Other - Last Name:SHARMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:820 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2120
Mailing Address - Country:US
Mailing Address - Phone:865-376-3406
Mailing Address - Fax:865-376-9091
Practice Address - Street 1:820 W RACE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2120
Practice Address - Country:US
Practice Address - Phone:865-376-3406
Practice Address - Fax:865-376-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030690207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704598Medicaid
TN38303561Medicaid
TN7944798OtherAETNA
TNQ026084Medicaid
TN4167588OtherBCBS
TN4394936OtherCIGNA
TNTN0160OtherJOHN DEERE/UHC
TN1522673Medicaid
TN3704598Medicare PIN
TN103I112109Medicare PIN
TN4394936OtherCIGNA