Individual
FARID ABDULREHMAN THANAWALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
919 CONFERENCE DR STE 4, GOODLETTSVILLE, TN 37072-1924
(615) 788-9324
Mailing address
919 CONFERENCE DR, SUITE #4, BOX 167, GOODLETTSVILLE, TN 37072-1924
(615) 788-9324
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-39312
KS
2085R0202X
Diagnostic Radiology Physician
217086
MA
2085R0202X
Diagnostic Radiology Physician
24890
NE
2085R0202X
Diagnostic Radiology Physician
56250
CO
2085R0202X
Diagnostic Radiology Physician
MD18855
HI
2085R0204X
Vascular & Interventional Radiology Physician
217086
MA
2085R0204X
Vascular & Interventional Radiology Physician
24890
NE
2085R0204X
Vascular & Interventional Radiology Physician
Primary
54593
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
$$$$$$$$$
—
NE
05
—
1770558496
—
IA
05
—
1770558496
—
MT
05
—
1770558496
—
SD
05
—
191281
—
AZ
05
—
200659440A
—
OK
05
—
201141130A
—
KS
05
—
2015757
—
MA
05
—
82653844
—
CO
05
—
87881730
—
NM
01
—
A35829
MEDICARE ID
MA
Enumeration date
02/17/2006
Last updated
01/19/2023
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