Healthcare Provider Details

I. General information

NPI: 1306873229
Provider Name (Legal Business Name): RONALD M FAIRMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 4 SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 4 SILVERSTEIN BUILDING
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2050
  • Fax: 215-349-8195
Mailing address:
  • Phone: 215-662-2050
  • Fax: 215-349-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD021126E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: