1053351718 NPI number — PAULA MARY FARNER MD

Table of content: PAULA MARY FARNER MD (NPI 1053351718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053351718 NPI number — PAULA MARY FARNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARNER
Provider First Name:
PAULA
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARNER
Provider Other First Name:
PAULA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053351718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36595 DETROIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44011-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-934-4070
Provider Business Mailing Address Fax Number:
440-934-4884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36595 DETROIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44011-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-934-4070
Provider Business Practice Location Address Fax Number:
440-934-4884
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35047906 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0629038 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 942460636329 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".