Provider Demographics
NPI:1346577376
Name:FARRINGTON, MARK GORDON (NP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:GORDON
Last Name:FARRINGTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4310
Mailing Address - Country:US
Mailing Address - Phone:434-760-3210
Mailing Address - Fax:
Practice Address - Street 1:730 LYONS AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4310
Practice Address - Country:US
Practice Address - Phone:434-760-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001085702163W00000X
VA0015000702364SP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5511071Medicaid
VA4945018Medicaid
VAP60917Medicare UPIN
VA5511071Medicaid
VA4945018Medicaid