Provider Demographics
NPI:1922325315
Name:FARRELLY, EWA B (MD)
Entity Type:Individual
Prefix:DR
First Name:EWA
Middle Name:B
Last Name:FARRELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:351 HOSPITAL RD STE 406
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3506
Mailing Address - Country:US
Mailing Address - Phone:949-646-7733
Mailing Address - Fax:949-646-6155
Practice Address - Street 1:351 HOSPITAL RD STE 406
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3506
Practice Address - Country:US
Practice Address - Phone:949-646-7733
Practice Address - Fax:949-646-6155
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA114221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI481ZMedicare PIN