Healthcare Provider Details

I. General information

NPI: 1942628672
Provider Name (Legal Business Name): DR. CLAIRE KENDIG FAGGONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. CLAIRE KENDIG

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LEHIGH AVE
PHILADELPHIA PA
19125-1012
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 152-707-1840
  • Fax: 215-707-8570
Mailing address:
  • Phone: 318-572-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD464786
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: