Individual
MOHAMMAD FAROOQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1714 E HUNDRED RD STE 101, CHESTER, VA 23836-3310
(804) 590-6750
Mailing address
12712 BAY HILL DR, CHESTER, VA 23836-2680
(804) 590-6750
(804) 681-0782
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101055927
VA
207RP1001X
Pulmonary Disease Physician
0101055927
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005811074
—
VA
01
—
290010581
MEDICARE RAILROAD
VA
01
—
C05898
MEDICARE GROUP NUMBER
—
01
—
C06778
GROUP PTAN
VA
01
—
CI3965
MEDICARE RR GROUP
VA
Enumeration date
03/17/2006
Last updated
08/09/2019
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