Provider Demographics
NPI:1346249067
Name:FARREN, GEORGIANNA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:FARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 REDWOOD BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4569
Mailing Address - Country:US
Mailing Address - Phone:415-798-3103
Mailing Address - Fax:415-892-8732
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:415-892-9732
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59600Medicaid
CAG59600Medicaid