MEDICARE: DR. KENNETH GARY FARBER DO

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	207Q00000X	Family Medicine Physician	34005486F	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831192012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH GARY FARBER DO

Provider Business Mailing Address
First Line	:	7589 TYLERS PLACE BLVD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6308
Country	:	US
Telephone Number	:	513-755-4700
Fax Number	:	513-755-4717

Provider Business Practice Location Address
First Line	:	7589 TYLERS PLACE BLVD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6308
Country	:	US
Telephone Number	:	513-755-4700
Fax Number	:	513-755-4717

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/22/2020

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