Provider Demographics
NPI:1063595296
Name:FARRELL, LEO D (MD)
Entity type:Individual
Prefix:MR
First Name:LEO
Middle Name:D
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2025 TECHNOLOGY PKWY
Mailing Address - Street 2:STE 204
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-732-9000
Mailing Address - Fax:717-732-9011
Practice Address - Street 1:2025 TECHNOLOGY PKWY
Practice Address - Street 2:STE 204
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-732-9000
Practice Address - Fax:717-732-9011
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032080E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01065901OtherCAP BLUE CROSS
91162OtherHEALTH AMERICA
91162OtherHEALTH AMERICA
E45227Medicare UPIN