Individual
FREDERIC THOMAS FARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 CAMPUS BLVD, SUITE 201, WINCHESTER, VA 22601
(540) 662-0306
(540) 542-1843
Mailing address
190 CAMPUS BLVD, SUITE 201, WINCHESTER, VA 22601
(540) 662-0306
(540) 542-1843
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101041773
VA
207RI0011X
Interventional Cardiology Physician
Primary
0101041773
VA
207RI0011X
Interventional Cardiology Physician
25172
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000875693
WV BLUE SHIELD GROUP #
—
01
—
001717440
WV BLUE SHIELD
—
01
—
006056954
VA MEDICAID PROFESSIONAL
—
05
—
006056954
—
VA
05
—
0085544000
—
WV
01
—
072370
ANTHEM PROFESSIONAL
—
01
—
08243200000
QUALCHOICE PROFESSIONAL
—
01
—
2119636
MAMSI PROFESSIONAL
—
05
—
286101100
—
MD
01
—
3810003817
WV MEDICAID GROUP
WV
01
—
44153
SENTARA PROFESSIONAL
—
01
—
550941600
MD MEDICAID GROUP
MD
01
—
C00085
VA MEDICARE B GROUP #
—
01
—
P00656329
RAILROAD MEDICARE
—
Enumeration date
04/06/2006
Last updated
01/06/2015
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