=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396942652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARRELL AND SCHAEFER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 08/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11055 LITTLE PATUXENT PKWY SUITE 107
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-2896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-964-8777
-----------------------------------------------------
Fax | 410-964-0894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11055 LITTLE PATUXENT PKWY SUITE 107
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-2896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-964-8777
-----------------------------------------------------
Fax | 410-964-0894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JENNIFER REAGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-864-8777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------