Provider Demographics
NPI:1154551463
Name:FARRELL, CAITLIN ANN (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:DIVISION OF EMERGENCY MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6624
Mailing Address - Fax:617-730-0335
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DIVISION OF EMERGENCY MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6624
Practice Address - Fax:617-730-0335
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194862208000000X
MA250865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics