Provider Demographics
NPI:1447367156
Name:FARRELL, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-961-5558
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:320 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3410
Practice Address - Country:US
Practice Address - Phone:859-341-4266
Practice Address - Fax:859-341-1912
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY233272084N0400X
OH35-0566442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000019938OtherANTHEM PROVIDER NUMBER
2549974-002OtherCIGNA PROVIDER NUMBER
IN200070240AMedicaid
KY64233273Medicaid
13750OtherNATIONWIDE HEALTH PROVIDE
311412447048OtherCARESOURCE PROVIDER NUMBE
05-20162OtherUNITED HEALTHCARE PROVIDE
130010610OtherRAILROAD MEDICARE
642183OtherAETNA PROVIDER NUMBER
OH0667283Medicaid
2549974-002OtherCIGNA PROVIDER NUMBER
OHFA0615192Medicare ID - Type Unspecified
IN200070240AMedicaid