Provider Demographics
NPI:1346349743
Name:FARIDA FARZANA
Entity type:Organization
Organization Name:FARIDA FARZANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-3447
Mailing Address - Street 1:3115 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2303
Mailing Address - Country:US
Mailing Address - Phone:314-644-3447
Mailing Address - Fax:
Practice Address - Street 1:3115 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2303
Practice Address - Country:US
Practice Address - Phone:314-644-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR68172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09820Medicare UPIN