1932198504 NPI number — ELENA R FARRELL DO

Table of content: ELENA R FARRELL DO (NPI 1932198504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932198504 NPI number — ELENA R FARRELL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
ELENA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1932198504
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:
4386 STURBRIDGE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-652-4924
Provider Business Mailing Address Fax Number:
717-652-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4386 STURBRIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-3668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-4924
Provider Business Practice Location Address Fax Number:
717-652-1015
Provider Enumeration Date:
10/17/2005

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: 207W00000X , with the licence number:  0S008191L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1412549 . This is a "KEYSTONE SR BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27085 . This is a "HEALTH GUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 392493 . This is a "NVA DOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50003172 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5766476 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202749 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39808 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1412549 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA8191 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 167531 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO36061 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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