Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD021037E | PA |
NPI | 1033122460 |
---|---|
Provider Name | Dorothy Farrell |
First Address | Kingston, PA 18704-3702 |
Second Address | Kingston, PA 18704-4566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C33658 | (02) |