1811942311 NPI number — FAIRHILL FAMILY MEDICINE SPECIALISTS, LLC

Table of content: (NPI 1811942311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811942311 NPI number — FAIRHILL FAMILY MEDICINE SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRHILL FAMILY MEDICINE SPECIALISTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811942311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
361 FAIR HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21921-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-620-7260
Provider Business Mailing Address Fax Number:
410-620-7262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
361 FAIR HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-620-7260
Provider Business Practice Location Address Fax Number:
410-620-7262
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
BONNI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
410-620-7260

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189CFA . This is a "CAREFIRST GROUP NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DE0145 . This is a "MCR RAILROAD GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com