Individual
EMILY REBECCA FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75 E STREET RD, FEASTERVILLE TREVOSE, PA 19053-6047
(267) 684-1047
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OA004782
PA
363A00000X
Physician Assistant
Primary
MA061525
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OA004782
PHYSICIAN ASSISTANT LICENSE NUMBER
PA
Enumeration date
02/14/2019
Last updated
01/20/2021
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