1356766752 NPI number — DR. CARNILLE PATRICE FARQUHARSON M.D.

Table of content: DR. CARNILLE PATRICE FARQUHARSON M.D. (NPI 1356766752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356766752 NPI number — DR. CARNILLE PATRICE FARQUHARSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARQUHARSON
Provider First Name:
CARNILLE
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1356766752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THOMPSON LANE
Provider Second Line Business Mailing Address:
STAPLEDON GARDENS
Provider Business Mailing Address City Name:
NEW PROVIDENCE
Provider Business Mailing Address State Name:
WEST INDIES
Provider Business Mailing Address Postal Code:
SP60568
Provider Business Mailing Address Country Code:
BS
Provider Business Mailing Address Telephone Number:
242-326-1666
Provider Business Mailing Address Fax Number:
242-326-1665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 STEUART ST
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94105-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-504-3838
Provider Business Practice Location Address Fax Number:
415-504-1367
Provider Enumeration Date:
02/22/2014

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: 207Q00000X , with the licence number:  055217 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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