1043223795 NPI number — MS. SALLY YVONNE FARR NP

Table of content: MS. SALLY YVONNE FARR NP (NPI 1043223795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043223795 NPI number — MS. SALLY YVONNE FARR NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARR
Provider First Name:
SALLY
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043223795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 N HOWARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-576-1400
Provider Business Mailing Address Fax Number:
410-576-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1560 OPESSUMTOWN PIKE
Provider Second Line Business Practice Location Address:
STE 18
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-662-7171
Provider Business Practice Location Address Fax Number:
301-620-9443
Provider Enumeration Date:
08/14/2006

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: 363L00000X , with the licence number:  R129867 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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