Provider Demographics
NPI:1255323614
Name:FARRELL, HOWARD A (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:FARRELL
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 1:1521 MCLURE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6174
Mailing Address - Country:US
Mailing Address - Phone:843-665-2900
Mailing Address - Fax:843-629-8122
Practice Address - Street 1:1521 MCLURE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6174
Practice Address - Country:US
Practice Address - Phone:843-665-2900
Practice Address - Fax:843-629-8122
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19910207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3614Medicaid
SCGP3614Medicaid
8483Medicare PIN