MEDICARE: JOHN FARRAR PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1191	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	194350	OTHER	NC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0346E	OTHER	NC	BC

General Provider Information

NPI Number	:	1083798813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FARRAR PH.D.

Provider Business Mailing Address
First Line	:	1315 S GLENBURNIE RD
Second Line	:	STE. D-17
City	:	NEW BERN
State	:	NC
Zip	:	28562-2613
Country	:	US
Telephone Number	:	252-634-2855
Fax Number	:	252-634-2955

Provider Business Practice Location Address
First Line	:	1315 S GLENBURNIE RD
Second Line	:	STE. D-17
City	:	NEW BERN
State	:	NC
Zip	:	28562-2613
Country	:	US
Telephone Number	:	252-634-2855
Fax Number	:	252-634-2955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/09/2007

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Directions to “ JOHN FARRAR PH.D.” Practice Location

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