MEDICARE: MARYJANE A. FARR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	217712	NY
2	207R00000X	Internal Medicine Physician	61844	CT
3	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	217712	NY
4	207RC0000X	Cardiovascular Disease Physician	217712	NY
5	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	T2599	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	61844	OTHER	CT	CT STATE LICENSE

General Provider Information

NPI Number	:	1700976974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYJANE A. FARR MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:	212-305-7439

Provider Business Practice Location Address
First Line	:	5939 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-3720
Country	:	US
Telephone Number	:	214-645-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	09/10/2021

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Directions to “ MARYJANE A. FARR MD” Practice Location

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