Basic Information
| Provider Information | |||||||||
| NPI: | 1942479050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID M FAJGENBAUM MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | SUITE #103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | SUITE #103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | FAJGENBAUM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9198725296 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 24065 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.