MEDICARE: SU FAIRCHILD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	MD069929L	PA
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	0101250992	VA
3	207QA0505X	Adult Medicine Physician	0101250992	VA
4	207Q00000X	Family Medicine Physician	MD069929L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861488074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SU FAIRCHILD MD

Provider Business Mailing Address
First Line	:	PO BOX 974
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-0974
Country	:	US
Telephone Number	:	570-391-0104
Fax Number	:	888-414-5264

Provider Business Practice Location Address
First Line	:	2251 VALLEY AVE
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2755
Country	:	US
Telephone Number	:	540-215-2211
Fax Number	:	888-414-5264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/01/2025

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Directions to “ SU FAIRCHILD MD” Practice Location

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