Provider Demographics
NPI:1932198504
Name:FARRELL, ELENA R (DO)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4386 STURBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-652-4924
Mailing Address - Fax:717-652-1015
Practice Address - Street 1:4386 STURBRIDGE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3668
Practice Address - Country:US
Practice Address - Phone:717-652-4924
Practice Address - Fax:717-652-1015
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S008191L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1412549OtherKEYSTONE SR BLUE
27085OtherHEALTH GUARD
392493OtherNVA DOC
50003172OtherCAPITAL BLUE CROSS
5766476OtherAETNA
202749OtherCOVENTRY
39808OtherGEISINGER
1412549OtherBLUE SHIELD
PA8191OtherEYE MED
167531OtherUNISON
PO36061OtherCHAMPUS
5766476OtherAETNA
PO36061OtherCHAMPUS