Provider Demographics
NPI:1154507390
Name:GREGORY M FARRELL OD
Entity type:Organization
Organization Name:GREGORY M FARRELL OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-794-6161
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0159
Mailing Address - Country:US
Mailing Address - Phone:207-794-6161
Mailing Address - Fax:207-794-8805
Practice Address - Street 1:53 TRANSALPINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4223
Practice Address - Country:US
Practice Address - Phone:207-794-6161
Practice Address - Fax:207-794-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT739332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0515600001Medicare NSC