Individual
FARANAK E. MOGHADAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3357B CORRIDOR MARKETPLACE, LAUREL, MD 20724-2381
(301) 497-1820
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101269960
VA
207Q00000X
Family Medicine Physician
Primary
D0053640
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080171343
RAILROAD MEDICARE
MD
Enumeration date
04/20/2006
Last updated
11/11/2021
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