Healthcare Provider Details

I. General information

NPI: 1841416773
Provider Name (Legal Business Name): CATHERINE ELIZABETH FARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 BELAIR RD
BALTIMORE MD
21236-2401
US

IV. Provider business mailing address

5000 COX ROAD
BALTIMORE MD
21275-9047
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-4355
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002780
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: