Basic Information
| Provider Information | |||||||||
| NPI: | 1366419830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAIRCHILD | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6800 W CENTRAL AVE | ||||||||
| Address2: | UNIT K | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198411510 | ||||||||
| FaxNumber: | 4918411513 | ||||||||
| Practice Location | |||||||||
| Address1: | 6800 W CENTRAL AVE | ||||||||
| Address2: | UNIT K | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198411510 | ||||||||
| FaxNumber: | 4198411513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 05/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35060627 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0813267 | 05 | OH | MEDICAID | P00163047 | 01 | OH | RAIRROAD MEDICARE | OTHER |