Healthcare Provider Details

I. General information

NPI: 1275505802
Provider Name (Legal Business Name): BENJAMIN G FARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 STATLER BLVD
STAUNTON VA
24401-4894
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7470
  • Fax: 540-245-7471
Mailing address:
  • Phone: 540-932-4629
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058357
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: