Provider Demographics
NPI:1033232582
Name:FARRELL, KATHERINE PATRICIA (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:PATRICIA
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HARRY S TRUMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7031
Mailing Address - Country:US
Mailing Address - Phone:410-222-7252
Mailing Address - Fax:410-222-7088
Practice Address - Street 1:3 HARRY S TRUMAN PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7031
Practice Address - Country:US
Practice Address - Phone:410-222-7252
Practice Address - Fax:410-222-7088
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00183182083P0901X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLE77Medicare ID - Type Unspecified
MDF85736Medicare UPIN