Healthcare Provider Details

I. General information

NPI: 1366406795
Provider Name (Legal Business Name): ERIC N. FAERBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 A ST ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
PHILADELPHIA PA
19134-1043
US

IV. Provider business mailing address

924 ROCK CREEK RD
BRYN MAWR PA
19010-1923
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5230
  • Fax: 215-427-4378
Mailing address:
  • Phone: 610-525-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD023448E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: