Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0101039388 | VA |
NPI | 1013949148 |
---|---|
Provider Name | Joseph G Farr |
First Address | Manassas, VA 20110 |
Second Address | Manassas, VA 20110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007354941 | (05) | VA |
049407 | ANTHEM BCBS (01) | VA |
C47585 | (02) |