Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD032080E | PA |
NPI | 1063595296 |
---|---|
Provider Name | Mr. Leo D Farrell |
First Address | Mechanicsburg, PA 17050 |
Second Address | Mechanicsburg, PA 17050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01065901 | CAP BLUE CROSS (01) | PA |
91162 | HEALTH AMERICA (01) | |
E45227 | (02) |