Basic Information
| Provider Information | |||||||||
| NPI: | 1376513630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAJGENBAUM | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | STE # 103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | STE # 103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 24065 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.