Healthcare Provider Details

I. General information

NPI: 1861626376
Provider Name (Legal Business Name): ERIN ALICE FARRISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S CHURCH ST
MIDDLETOWN MD
21769-8043
US

IV. Provider business mailing address

PO BOX 20
MIDDLETOWN MD
21769-0020
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-9000
  • Fax: 301-371-8905
Mailing address:
  • Phone: 301-371-9000
  • Fax: 301-371-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD95976
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD95976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: