Individual
MARY FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
92 W MILLER ST, ORLANDO, FL 32806-2032
(321) 841-5104
(321) 841-6871
Mailing address
92 W MILLER ST, ORLANDO, FL 32806-2032
(321) 841-5104
(321) 841-6871
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME42646
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069192501
—
FL
01
—
47655U
MEDICARE PTAN
FL
Enumeration date
08/25/2006
Last updated
09/03/2024
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