Provider Demographics
NPI:1932145190
Name:FARLEY, PATRICIA LOGAN (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOGAN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:717-447-0340
Mailing Address - Fax:717-447-0344
Practice Address - Street 1:106 DERRY HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-8604
Practice Address - Country:US
Practice Address - Phone:717-447-0340
Practice Address - Fax:717-447-0344
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010501-L207Q00000X
PAOS010501L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001861013Medicaid
PA0018610130004Medicaid
PA0018610130004Medicaid
H42985Medicare UPIN
049449Medicare PIN