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Individual
SEAN FAHERTY
Active
Individual
SEAN FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
98-47
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080153393
RAILROAD RETIREMENT
—
01
—
12988
LOEVLACE
NM
01
—
201013243
PRESBYTERIAN HEALTH PLAN
NM
01
—
32756
PRESBYTERIAN SALUD
NM
01
—
NM004194
BLUE CROSS
NM
05
—
Q3766
—
NJ
Enumeration date
01/09/2006
Last updated
08/20/2019
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