Healthcare Provider Details

I. General information

NPI: 1912988478
Provider Name (Legal Business Name): CHARLES P FARLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST STE 409
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

PO BOX 5520
BETHLEHEM PA
18015-0520
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5810
  • Fax: 610-954-5480
Mailing address:
  • Phone: 610-954-5810
  • Fax: 610-954-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN240461L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: