Provider Demographics
NPI:1871814194
Name:FARRELL, ANGELA TRACY (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:TRACY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:TRACY
Other - Last Name:SCHACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:319-384-7000
Mailing Address - Fax:319-467-7400
Practice Address - Street 1:3640 MIDDLEBURY RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2712
Practice Address - Country:US
Practice Address - Phone:319-384-7000
Practice Address - Fax:319-467-7400
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8880207Q00000X
IA40668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine