Provider Demographics
NPI:1760458616
Name:MOFID-WOO, FOROUZANDEH FARAH (MD)
Entity type:Individual
Prefix:DR
First Name:FOROUZANDEH
Middle Name:FARAH
Last Name:MOFID-WOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FARAH
Other - Middle Name:F
Other - Last Name:KHAYAT-MOFID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1168
Practice Address - Country:US
Practice Address - Phone:540-921-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG62883Medicare UPIN