Provider Demographics
NPI:1730166695
Name:NIROOMAND, FARHAD (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:NIROOMAND
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 1:2501 OAK LAWN AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4090
Mailing Address - Country:US
Mailing Address - Phone:214-303-1102
Mailing Address - Fax:
Practice Address - Street 1:2501 OAK LAWN AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4090
Practice Address - Country:US
Practice Address - Phone:214-303-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752762339207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1276149-01Medicaid
TXTXB149809Medicare PIN
TXF19923Medicare UPIN