Provider Demographics
NPI:1992930804
Name:AKHTAR, FARAZ (MD)
Entity type:Individual
Prefix:
First Name:FARAZ
Middle Name:
Last Name:AKHTAR
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 1:1001 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3825
Mailing Address - Country:US
Mailing Address - Phone:919-833-3111
Mailing Address - Fax:919-834-3118
Practice Address - Street 1:1011 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3825
Practice Address - Country:US
Practice Address - Phone:919-833-3111
Practice Address - Fax:919-834-3118
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00722207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFA1409588OtherDEA
KY000000636531OtherANTHEM BCBS
181835Medicare Oscar/Certification
NCNCF437DMedicare PIN
NCNCF437AMedicare PIN
NCNCF437CMedicare PIN
KY7100082440Medicaid
NCNCF437EMedicare PIN
KY0322519Medicare PIN
NCNCF437BMedicare PIN