Jonathan T Fanburg
Adolescent Medicine
5 Bucknam Road Suite 1d
Falmouth
, Maine 04105-1208
Jonathan T Fanburg
Adolescent Medicine
5 Bucknam Road Suite 1d
Falmouth
, Maine 04105-1208
(207) 396-8632
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Jonathan T Fanburg
- 301c Us Route 1
- Scarborough, ME
- Zip : 04074-9701
- Fax : (207) 396-8632
- Phone : (207) 396-8600
Second Address
- Jonathan T Fanburg
- 5 Bucknam Road Suite 1d
- Falmouth, ME
- Zip : 04105-1208
- Fax : (207) 781-1780
- Phone : (207) 781-1775
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | MD14878 | ME |
National Provider Identifier
| NPI | 1275574311 |
|---|---|
| Provider Name | Jonathan T Fanburg |
| First Address | Scarborough, ME 04074-9701 |
| Second Address | Falmouth, ME 04105-1208 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/06/2006 |
| Last Update Date | 26/06/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 282610099 | (05) | ME |
| G20164 | (02) | ME |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.