Provider Demographics
NPI:1093034845
Name:FARABAUGH, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:FARABAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7300
Mailing Address - Fax:717-845-4625
Practice Address - Street 1:2775 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-3020
Practice Address - Country:US
Practice Address - Phone:717-812-7300
Practice Address - Fax:717-845-4625
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196767207Q00000X
PAMD448034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102835020Medicaid
PA2897435OtherHIGHMARK BLUE SHIELD
PA420538OtherUPMC
PA291822FLTMedicare PIN
PA2897435OtherHIGHMARK BLUE SHIELD