Provider Demographics
NPI:1427080571
Name:FARRAR, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:FARRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:423 GUARDIAN DR
Mailing Address - Street 2:816 BLOCKLEY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-898-5802
Mailing Address - Fax:215-573-5315
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:PENN MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-349-8310
Practice Address - Fax:215-662-2739
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044835L2084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001276130001Medicaid
PA001276130001Medicaid
PA689906Medicare PIN