Provider Demographics
NPI:1518994573
Name:FARRAGO, DOUGLAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:FARRAGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1149 VISTA PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4684
Mailing Address - Country:US
Mailing Address - Phone:434-616-2455
Mailing Address - Fax:434-253-1806
Practice Address - Street 1:1149 VISTA PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4684
Practice Address - Country:US
Practice Address - Phone:434-616-2455
Practice Address - Fax:434-253-1806
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME014273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME294100099Medicaid
MEG51277Medicare UPIN
ME294100099Medicaid