Fanburg, Jonathan T

Fanburg, Jonathan T is an individual health care provider with primary practice located at 5 Bucknam Road Suite 1D, Falmouth ME 04105-1208. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Fanburg, Jonathan T can be contacted via phone (207) 781-1775.

Contact Information

Primary practice address
5 Bucknam Road Suite 1D Falmouth ME 04105-1208
Phone: (207) 781-1775
Fax: (207) 781-1780
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X MD14878 Maine

Profile Details

NPI number 1275574311
LBN Legal business name Fanburg, Jonathan T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Jun 26th, 2012 - about 13 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 1275574311 NPPES
Maine MEDICAID 282610099

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