Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD14752 | ME |
NPI | 1003858895 |
---|---|
Provider Name | Dr. Mary C. Fahrenbach |
First Address | Scarborough, ME 04074 |
Second Address | Scarborough, ME 04074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 26/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036238 | ANTHEM (01) | |
296830099 | (05) | ME |
30200169 | (05) | NH |
E97799 | (02) |