Basic Information
| Provider Information | |||||||||
| NPI: | 1659430551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARNSWORTH | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 27 | ||||||||
| Address2: | |||||||||
| City: | JAMESVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130780027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153456930 | ||||||||
| FaxNumber: | 3154924800 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 LANSING ST | ||||||||
| Address2: | AUBURN COMMUNITY HOSPITAL, DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670437 | ||||||||
| FaxNumber: | 3152551702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 193034 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00354485 | 05 | NY | MEDICAID | J100095645 | 05 | NY | MEDICAID | 01449912 | 05 | NY | MEDICAID | 000003652 | 01 | NY | BLUE SHIELD | OTHER |