Healthcare Provider Details

I. General information

NPI: 1740939552
Provider Name (Legal Business Name): SAMUEL FARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4000
  • Fax:
Mailing address:
  • Phone: 610-237-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD493512
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: