Provider Demographics
NPI:1710130901
Name:FARRUGIA, DANIEL JOSEPH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:FARRUGIA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3371
Mailing Address - Country:US
Mailing Address - Phone:815-455-2752
Mailing Address - Fax:815-455-2789
Practice Address - Street 1:631 PROFESSIONAL DR STE 300
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3371
Practice Address - Country:US
Practice Address - Phone:770-962-9977
Practice Address - Fax:770-339-9804
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0816842086X0206X
PAMD4542092086X0206X
IL0361417682086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13967OtherTRN
IL036141768OtherSTATE LICENSE