Provider Demographics
NPI:1497964597
Name:FARABAUGH, DANA C (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
Last Name:FARABAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:ELIZABETH
Other - Last Name:CASTAFERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 1900
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-6510
Mailing Address - Fax:302-733-3340
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1900
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-6510
Practice Address - Fax:302-733-3340
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434145207V00000X
DEC1-0013460207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07496OtherMEDICAID BC BS
2168541OtherUHC/MAMSI
PA102162216Medicaid
VA1497964597Medicaid
VA014072E30Medicare PIN
PA127560MQ3Medicare PIN
NC5907496Medicaid
PA3513429000OtherIBC
VA304833OtherANTHEM FF