Provider Demographics
NPI:1568929636
Name:FARRELL, RORY JOSEPH (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:RORY
Middle Name:JOSEPH
Last Name:FARRELL
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2019
Mailing Address - Country:US
Mailing Address - Phone:949-842-9895
Mailing Address - Fax:
Practice Address - Street 1:CAMP PENDLETON
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:00000
Practice Address - Country:US
Practice Address - Phone:760-725-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman