Individual
NICOLAS MAX FARENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102208567
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
34.017747
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
VA
Other
Enumeration date
04/02/2021
Last updated
10/27/2025
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