Provider Demographics
NPI:1104858091
Name:FARIS, MARY RACHEL
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:RACHEL
Last Name:FARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:ABINGTON CANCER CARE SPECIALISTS
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-2400
Mailing Address - Fax:215-481-7438
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:ABINGTON CANCER CARE SPECIALISTS
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-2400
Practice Address - Fax:215-481-7438
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055169L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001722234Medicaid
PAD45308Medicare UPIN
PA001722234Medicaid