Provider Demographics
NPI:1992933345
Name:FARHANG, PEJMAN (MD)
Entity type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:FARHANG
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 1:1625 N GEORGE MASON DR STE 345
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3690
Mailing Address - Country:US
Mailing Address - Phone:703-717-4400
Mailing Address - Fax:703-717-4401
Practice Address - Street 1:1625 N GEORGE MASON DR STE 345
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3690
Practice Address - Country:US
Practice Address - Phone:703-717-4400
Practice Address - Fax:703-717-4401
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263090207R00000X, 208M00000X
FLME113400208M00000X
390200000X
GA65766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005961200Medicaid
FLGL847XMedicare PIN