Provider Demographics
NPI:1093783466
Name:FARLEY, DONALD R (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 WEST 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-964-5595
Mailing Address - Fax:440-964-5003
Practice Address - Street 1:161 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3449
Practice Address - Country:US
Practice Address - Phone:440-352-2201
Practice Address - Fax:440-352-0242
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002243213E00000X
OH36002243213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0585531Medicaid
OH0565891Medicare PIN
OHT80752Medicare UPIN
OH0632870001Medicare NSC
OH480003594Medicare PIN