Provider Demographics
NPI:1184713364
Name:FARRAH, VICTOR BYRON (DO)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:BYRON
Last Name:FARRAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4705 S HIGHWAY 150 STE B&C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5677
Practice Address - Country:US
Practice Address - Phone:336-481-1780
Practice Address - Fax:336-481-1789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2837806OtherUHC GRP
NC4545406OtherCIGNA
NC891023LMedicaid
NC1023LOtherBCBS
NC232054OtherMEDICARE PTAN
NC18787OtherPARTNERS
130156OtherUHC INDIV
NC4545406OtherCIGNA
NC891023LMedicaid