Provider Demographics
NPI:1548910060
Name:FARA MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:FARA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARAMADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERUANGA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC FNPBC
Authorized Official - Phone:240-606-9176
Mailing Address - Street 1:2883 FALKIRK ALY
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-7017
Mailing Address - Country:US
Mailing Address - Phone:240-606-9176
Mailing Address - Fax:
Practice Address - Street 1:6525 KENOVA ST
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2835
Practice Address - Country:US
Practice Address - Phone:240-606-9176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty