Provider Demographics
NPI:1407219769
Name:FARLEY, LOREN (MD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
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 1:125 DOAN HALL
Mailing Address - Street 2:410 WEST 10TH AVENUE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-7326
Mailing Address - Fax:614-293-7966
Practice Address - Street 1:125 DOAN HALL
Practice Address - Street 2:410 WEST 10TH AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-7326
Practice Address - Fax:614-293-7966
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.135700390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program