Provider Demographics
NPI:1104897172
Name:FARRELL, DONNA R (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-7924
Mailing Address - Fax:214-947-0187
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 156
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-7924
Practice Address - Fax:214-947-0187
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006848L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1257214Medicaid
PA080095806OtherRAILROAD MEDICARE
PAE94312Medicare UPIN
PA1257214Medicaid
PA681562EQ2Medicare PIN