Healthcare Provider Details

I. General information

NPI: 1982166526
Provider Name (Legal Business Name): JASON TODD FARRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

1216 GARRITY BLVD
NAMPA ID
83687-3402
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6787
  • Fax:
Mailing address:
  • Phone: 208-343-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3671876
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: