Healthcare Provider Details

I. General information

NPI: 1780751909
Provider Name (Legal Business Name): MICHAEL A FARRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR SUITE 109
BINGHAMTON NY
13905-4176
US

IV. Provider business mailing address

161 RIVERSIDE DR SUITE 109
BINGHAMTON NY
13905-4176
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-7074
  • Fax: 607-770-3452
Mailing address:
  • Phone: 607-770-7074
  • Fax: 607-770-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number175144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: