Provider Demographics
NPI:1609812635
Name:FARRELL, MEGAN O (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:O
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 COMO PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1416
Mailing Address - Country:US
Mailing Address - Phone:716-686-8460
Mailing Address - Fax:716-686-8100
Practice Address - Street 1:225 COMO PARK BLVD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1416
Practice Address - Country:US
Practice Address - Phone:716-686-8460
Practice Address - Fax:716-686-8100
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177917207QH0002X, 2081H0002X, 208VP0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01375075Medicaid
NYE35935Medicare UPIN
RB8063Medicare PIN