Healthcare Provider Details

I. General information

NPI: 1053351718
Provider Name (Legal Business Name): PAULA MARY FARNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULA M FARNER MD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36595 DETROIT RD
AVON OH
44011-1509
US

IV. Provider business mailing address

36595 DETROIT RD
AVON OH
44011-1509
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-4070
  • Fax: 440-934-4884
Mailing address:
  • Phone: 440-934-4070
  • Fax: 440-934-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35047906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: