Provider Demographics
NPI:1275505802
Name:FARLEY, BENJAMIN G (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:FARLEY
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:851 STATLER BLVD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4894
Practice Address - Country:US
Practice Address - Phone:540-245-7470
Practice Address - Fax:540-245-7471
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA324671OtherANTHEM
VA005634598Medicaid
VA2182339OtherFIRST HEALTH
VA41421OtherOPTIMA
VA5634598OtherVIRGINIA PREMIER
VA142652OtherSOUTHERN HEALTH
VA10787OtherCIGNA
VAG84387Medicare UPIN
VA080006860Medicare ID - Type Unspecified
VA5634598OtherVIRGINIA PREMIER
VA324671OtherANTHEM
VA005634598Medicaid