Basic Information
| Provider Information | |||||||||
| NPI: | 1679579361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10403 HOSPITAL DR | ||||||||
| Address2: | STE G4 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207353137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018563019 | ||||||||
| FaxNumber: | 3018569370 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 SAINT PATRICKS DR | ||||||||
| Address2: | STE 203 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206034527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018430222 | ||||||||
| FaxNumber: | 3018430651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 03/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0002237 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 45231900 | 05 | MD | MEDICAID | B766-0011 | 01 | DC | BCBS DC | OTHER | 1851473722 | 01 | MD | GROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND | OTHER | 1780629683 | 01 | MD | GROUP NPI - WALDORF FAMILY MEDICAL CENTER | OTHER | 41337401 | 01 | MD | BCBS MD | OTHER | 100011664 | 01 | MD | RAILROAD MEDICARE | OTHER |