Provider Demographics
NPI:1679627434
Name:FARTHING, CHARLENE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:M
Last Name:FARTHING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHARLENE
Other - Middle Name:M
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:280 VIRGINIA AVE NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1538
Mailing Address - Country:US
Mailing Address - Phone:276-365-8071
Mailing Address - Fax:949-862-3723
Practice Address - Street 1:280 VIRGINIA AVE NE
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1538
Practice Address - Country:US
Practice Address - Phone:276-365-8071
Practice Address - Fax:949-862-3723
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0010-003809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB625AOtherPTAN
VAVVB625AOtherPTAN