Healthcare Provider Details

I. General information

NPI: 1689484875
Provider Name (Legal Business Name): FARTHING DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD N STE 101
NOBLESVILLE IN
46060-4370
US

IV. Provider business mailing address

10570 GARDNER CT
FORTVILLE IN
46040-9277
US

V. Phone/Fax

Practice location:
  • Phone: 317-903-2346
  • Fax:
Mailing address:
  • Phone: 317-764-2141
  • Fax: 317-764-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN FARTHING
Title or Position: CEO
Credential: MD
Phone: 317-764-2141