Basic Information
| Provider Information | |||||||||
| NPI: | 1962454298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FARMER | ||||||||
| OtherFirstName: | D. | ||||||||
| OtherMiddleName: | MICHAEL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 MOUNT AUBURN ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174971560 | ||||||||
| FaxNumber: | 6174971109 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174971560 | ||||||||
| FaxNumber: | 6174971109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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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 | 207R00000X | 221294 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 221294 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 96478001 | 01 | MA | NETWORK HEALTH PLAN | OTHER | 0037770 | 01 | MA | NEIGHBORHOOD HEALTHPLAN | OTHER | 478911 | 01 | MA | TUFTS | OTHER | AA55331 | 01 | MA | HARVARD PILGRIM HEALTHCARE | OTHER | 2097541 | 05 | MA | MEDICAID | 1962454298 | 01 | MA | BOSTON MEDICAL CENTER HEALTH NET PLAN | OTHER | 115032 | 01 | MA | FALLON HEALTH PLAN | OTHER | 1200723 | 01 | MA | AETNA HEALTHCARE | OTHER | 9747674 | 01 | MA | CIGNA HEALTHPLAN | OTHER |