Healthcare Provider Details

I. General information

NPI: 1558627372
Provider Name (Legal Business Name): BLAIR FARR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WISCONSIN AVE NW 4TH FLOOR
WASHINGTON DC
20016-2143
US

IV. Provider business mailing address

4200 WISCONSIN AVE NW 4TH FLOOR
WASHINGTON DC
20016-2143
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-3400
  • Fax:
Mailing address:
  • Phone: 202-243-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD043389
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: