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General NPI Number Information
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NPI Number | 1184990004
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Entity Type | Individual
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Provider Name | ENE THERESE RAIG FAIRCHILD MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2012
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 3535 OLENTANGY RIVER RD
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City | COLUMBUS
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State | OH
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Zip | 43214
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Country | US
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Telephone | 614-566-4731
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Fax |
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Provider Business Mailing Address
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Address Line | 6549 BALLANTRAE PL
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City | DUBLIN
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State | OH
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Zip | 43016-6050
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Country | US
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Telephone | 614-209-7040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.123030
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35.123030
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License Number State | OH
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