Provider Demographics
NPI:1053351718
Name:FARNER, PAULA MARY (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARY
Last Name:FARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:FARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:36595 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1509
Mailing Address - Country:US
Mailing Address - Phone:440-934-4070
Mailing Address - Fax:440-934-4884
Practice Address - Street 1:36595 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1509
Practice Address - Country:US
Practice Address - Phone:440-934-4070
Practice Address - Fax:440-934-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629038Medicaid
OH942460636329OtherCARESOURCE
OH942460636329OtherCARESOURCE