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General NPI Number Information
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NPI Number | 1689484875
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Entity Type | Organization
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Legal Business Name | FARTHING DERMATOLOGY LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 14540 PRAIRIE LAKES BLVD N STE 101
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City | NOBLESVILLE
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State | IN
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Zip | 46060-4370
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Country | US
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Telephone | 317-903-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 10570 GARDNER CT
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City | FORTVILLE
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State | IN
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Zip | 46040-9277
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Country | US
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Telephone | 317-764-2141
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Fax | 317-764-2147
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN FARTHING
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Credential | MD
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Telephone | 317-764-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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