Provider Demographics
NPI:1376564013
Name:FARLEY, TRACI LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LOUISE
Last Name:FARLEY
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 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9314
Practice Address - Country:US
Practice Address - Phone:570-522-4110
Practice Address - Fax:570-768-3911
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425385207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1671113OtherBLUE SHIELD
PA321845OtherHEALTH AMERICA
PA50044509OtherCAPITAL BLUE CROSS
PAP00190420OtherRAILROAD MEDICARE
PA1012034590001Medicaid
PA232809429OtherTRICARE
PA50044509OtherCAPITAL BLUE CROSS