Healthcare Provider Details

I. General information

NPI: 1356931315
Provider Name (Legal Business Name): MARIA FARERI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3039 AMY DR
SOUTH PARK PA
15129-9371
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2277
  • Fax:
Mailing address:
  • Phone: 724-747-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062424
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: