Provider Demographics
NPI:1134344138
Name:FARRELL, PAULA ANN (MD)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 IRVING AVE
Mailing Address - Street 2:ROOM 9100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1687
Mailing Address - Country:US
Mailing Address - Phone:315-470-7379
Mailing Address - Fax:315-470-2923
Practice Address - Street 1:800 ROSE ST FL 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2107
Practice Address - Country:US
Practice Address - Phone:859-562-1085
Practice Address - Fax:859-257-5152
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP2542080N0001X
NY2271642080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02721786Medicaid