Healthcare Provider Details

I. General information

NPI: 1063581999
Provider Name (Legal Business Name): DEBORAH A FARIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 GLENWAY AVE MEDICAL DEPARTMENT
CINCINNATI OH
45211-6312
US

IV. Provider business mailing address

3688 CRESTNOLL LN
CINCINNATI OH
45211-1816
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-3399
  • Fax:
Mailing address:
  • Phone: 513-661-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.000537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: