Provider Demographics
NPI:1033328430
Name:FARRELL, KATHLEEN FREKKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:FREKKO
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:818 WEST DIAMOND AVENUE
Mailing Address - Street 2:STE 130
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-948-8780
Mailing Address - Fax:301-519-9093
Practice Address - Street 1:818 WEST DIAMOND AVENUE
Practice Address - Street 2:STE 130
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-948-8780
Practice Address - Fax:301-519-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87614Medicare UPIN