Provider Demographics
NPI:1740434364
Name:RICHARD M GOLDFARB MD FACS LLC
Entity type:Organization
Organization Name:RICHARD M GOLDFARB MD FACS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-547-9570
Mailing Address - Street 1:940 TOWN CENTER DR
Mailing Address - Street 2:SUITE F20
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1772
Mailing Address - Country:US
Mailing Address - Phone:215-702-1200
Mailing Address - Fax:215-702-1300
Practice Address - Street 1:940 TOWN CENTER DR
Practice Address - Street 2:SUITE F20
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1772
Practice Address - Country:US
Practice Address - Phone:215-702-1200
Practice Address - Fax:215-702-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038006E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE22010Medicare Oscar/Certification