Provider Demographics
NPI:1427097302
Name:MISAGHI, FAREDOON K (DO)
Entity type:Individual
Prefix:
First Name:FAREDOON
Middle Name:K
Last Name:MISAGHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:415 MORRIS STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:4602 MACCORKLE AVENUE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-925-4777
Practice Address - Fax:304-925-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV1598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4122733Medicare PIN
WVH98438Medicare UPIN
P00819498Medicare PIN