Healthcare Provider Details

I. General information

NPI: 1114972429
Provider Name (Legal Business Name): MARY LINDA FAIRBANKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LINDA KRECK FAIRBANKS MD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR
BETHESDA MD
20892-0004
US

IV. Provider business mailing address

10 CENTER DR
BETHESDA MD
20892-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-0877
  • Fax:
Mailing address:
  • Phone: 301-496-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0071536
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: