Provider Demographics
NPI:1679686406
Name:FARWELL, WILDON R (MD)
Entity Type:Individual
Prefix:
First Name:WILDON
Middle Name:R
Last Name:FARWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 SOUTH HUNTINGTON AVENUE
Mailing Address - Street 2:VA BOSTON HEALTHCARE MAVERIC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:857-364-6182
Mailing Address - Fax:857-364-6528
Practice Address - Street 1:1620 TREMONT STREET
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL DIVISION OF AGING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:857-364-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine