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Individual
DR. GAULT M FARRELL
Active
Individual
DR. GAULT M FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
213607
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000402108001
BLUE SHIELD OF NORTHEASTE
NY
05
—
01433123
—
NY
01
—
107286
BC UTICA
—
01
—
213607
LICENSE
—
01
—
2136077
WC
—
01
—
400638
MVP SELECT CARE
—
01
—
424B3
EMPIRE BLUE CROSS
NY
Enumeration date
10/20/2005
Last updated
03/07/2023
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