Provider Demographics
NPI:1992799035
Name:GHOGHAWALA, FARIDA M (MD)
Entity type:Individual
Prefix:DR
First Name:FARIDA
Middle Name:M
Last Name:GHOGHAWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FARIDA
Other - Middle Name:U
Other - Last Name:BAHAUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:33501 1ST WAY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6208
Practice Address - Country:US
Practice Address - Phone:253-874-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024819207V00000X
WAMD00046994207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0255400OtherL & I
WA8469686Medicaid
FLD58516Medicare UPIN
WAG8884929Medicare PIN