MEDICARE: DR. ANTHONY LOGAN FARROW

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS024757 L	PA

General Provider Information

NPI Number	:	1497815336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY LOGAN FARROW

Provider Business Mailing Address
First Line	:	1510 WADSWORTH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150
Country	:	US
Telephone Number	:	205-247-9060
Fax Number	:	215-247-9062

Provider Business Practice Location Address
First Line	:	1510 WADSWORTH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150
Country	:	US
Telephone Number	:	205-247-9060
Fax Number	:	215-247-9062

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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