Healthcare Provider Details

I. General information

NPI: 1134344138
Provider Name (Legal Business Name): PAULA ANN FARRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST FL 2
LEXINGTON KY
40536-2107
US

IV. Provider business mailing address

736 IRVING AVE ROOM 9100
SYRACUSE NY
13210-1687
US

V. Phone/Fax

Practice location:
  • Phone: 859-562-1085
  • Fax: 859-257-5152
Mailing address:
  • Phone: 315-470-7379
  • Fax: 315-470-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberTP254
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number227164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: