Provider Demographics
NPI:1386699239
Name:SAMIMI, FAROKH (MD)
Entity type:Individual
Prefix:DR
First Name:FAROKH
Middle Name:
Last Name:SAMIMI
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-882-6724
Mailing Address - Fax:570-882-6728
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-882-6724
Practice Address - Fax:570-882-6728
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038395L174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1133182Medicaid
PAGU039818OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PAP00337167OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PA1133182Medicaid