MEDICARE: CHARLES RICHARD FARABEE JR. PA

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	363AM0700X	Medical Physician Assistant	100715	NC

General Provider Information

NPI Number	:	1801872692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES RICHARD FARABEE JR. PA

Provider Business Mailing Address
First Line	:	PO BOX 5448
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27204-5448
Country	:	US
Telephone Number	:	336-625-2333
Fax Number	:	336-625-5511

Provider Business Practice Location Address
First Line	:	237 N FAYETTEVILLE ST STE A
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-5573
Country	:	US
Telephone Number	:	336-625-3248
Fax Number	:	336-625-6629

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	06/04/2013

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