Healthcare Provider Details

I. General information

NPI: 1003913211
Provider Name (Legal Business Name): FARRICY & KRAFT LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 560
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST SUITE 560
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-6100
  • Fax: 508-363-6206
Mailing address:
  • Phone: 508-363-6100
  • Fax: 508-363-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: MRS. LISSETTE SANTANA
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-363-6100