Provider Demographics
NPI:1417999640
Name:FARRAR, MARY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:FARRAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15117 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1763
Mailing Address - Country:US
Mailing Address - Phone:301-929-9048
Mailing Address - Fax:
Practice Address - Street 1:7 GRANITE PL
Practice Address - Street 2:SUITE 14
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6586
Practice Address - Country:US
Practice Address - Phone:240-631-1170
Practice Address - Fax:240-631-1031
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118801100Medicaid
MD011149G80Medicare ID - Type Unspecified
MDP84652Medicare UPIN