Provider Demographics
NPI:1730315813
Name:FARRICIELLI, JEFFREY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:FARRICIELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 QUEENSBOROUGH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5430
Mailing Address - Country:US
Mailing Address - Phone:843-901-2145
Mailing Address - Fax:877-670-7886
Practice Address - Street 1:1131 QUEENSBOROUGH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-901-2145
Practice Address - Fax:877-670-7886
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36306208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation