Healthcare Provider Details

I. General information

NPI: 1467415729
Provider Name (Legal Business Name): MICHAEL C FARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ROUTE 168 SUITE 301-305
TURNERSVILLE NJ
08012-3210
US

IV. Provider business mailing address

PO BOX 1710
VOORHEES NJ
08043-7710
US

V. Phone/Fax

Practice location:
  • Phone: 856-374-4031
  • Fax: 856-751-0535
Mailing address:
  • Phone: 856-770-0504
  • Fax: 856-751-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA07614300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07614300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: