1760461677 NPI number — DR. MARYANN FARMER DPM

Table of content: DR. MARYANN FARMER DPM (NPI 1760461677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760461677 NPI number — DR. MARYANN FARMER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARMER
Provider First Name:
MARYANN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1760461677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 RUGH STREET
Provider Second Line Business Mailing Address:
SUITE 3000
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-837-2657
Provider Business Mailing Address Fax Number:
724-837-5929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 RUGH ST.
Provider Second Line Business Practice Location Address:
SUITE 3000
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-2657
Provider Business Practice Location Address Fax Number:
724-837-5929
Provider Enumeration Date:
01/10/2006

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: 213EP1101X , with the licence number:  SC002434L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: SC002434L , 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: 75973 . This is a "MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 08776936 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5311285 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001347416 . This is a "KEYSTONE BLUES HMO - WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 942727 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: FA084057 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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