Provider Demographics
NPI:1457352767
Name:FARRELL, COLLEEN C (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:C
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 1:3456 BETHLEHEM PIKE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1051
Mailing Address - Country:US
Mailing Address - Phone:215-723-7177
Mailing Address - Fax:
Practice Address - Street 1:3456 BETHLEHEM PIKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1051
Practice Address - Country:US
Practice Address - Phone:215-723-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 422876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN