Provider Demographics
NPI:1447261615
Name:ASSAR, FARZAD (MD)
Entity type:Individual
Prefix:
First Name:FARZAD
Middle Name:
Last Name:ASSAR
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 1:1 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2643
Mailing Address - Country:US
Mailing Address - Phone:301-528-3580
Mailing Address - Fax:301-528-3589
Practice Address - Street 1:ONE EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:301-528-3580
Practice Address - Fax:301-528-3589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040201207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220131300Medicaid
MD220131300Medicaid
MDF48564Medicare UPIN