Provider Demographics
NPI:1770699613
Name:FAROOQI, SHAZIA HABIB (MD)
Entity type:Individual
Prefix:
First Name:SHAZIA
Middle Name:HABIB
Last Name:FAROOQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:11020 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3200
Practice Address - Country:US
Practice Address - Phone:804-744-6310
Practice Address - Fax:804-744-9199
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011889P95Medicare PIN
VAI71056Medicare UPIN
VA563385YWAUMedicare PIN