Healthcare Provider Details

I. General information

NPI: 1760461677
Provider Name (Legal Business Name): MARYANN FARMER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 RUGH ST. SUITE 3000
GREENSBURG PA
15601
US

IV. Provider business mailing address

545 RUGH STREET SUITE 3000
GREENSBURG PA
15601
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-2657
  • Fax: 724-837-5929
Mailing address:
  • Phone: 724-837-2657
  • Fax: 724-837-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC002434L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002434L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: