Healthcare Provider Details

I. General information

NPI: 1891766382
Provider Name (Legal Business Name): FAIRFIELD OB/GYN ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 E MAIN ST
LANCASTER PA
43130
US

IV. Provider business mailing address

PO BOX 20451
COLUMBUS OH
43220
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-7346
  • Fax: 614-451-5846
Mailing address:
  • Phone: 614-451-7346
  • Fax: 614-451-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number34004960G
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34004690G
License Number StateOH

VIII. Authorized Official

Name: MR. NATHANIEL P NOBLE
Title or Position: AGENT
Credential:
Phone: 614-451-7346