Fairbank, Jonathan T

Fairbank, Jonathan T is an sole proprietor health care provider with primary practice located at 111 Colchester Ave Dept. Of Radiology, Burlington VT 05401-1473. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nuclear Radiology, which is considered as his primary health care specialty. Fairbank, Jonathan T can be contacted via phone (802) 847-3592.

Contact Information

Primary practice address
111 Colchester Ave Dept. Of Radiology Burlington VT 05401-1473
Phone: (802) 847-3592
Fax: (802) 847-4822
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Radiology 2085N0904X 042-0003761 Vermont

Profile Details

NPI number 1184645814
LBN Legal business name Fairbank, Jonathan T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 21st, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184645814 NPPES
Vermont MEDICAID 4755

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