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Individual
SAMANTHA FAIRCHILD
Active
Individual
SAMANTHA FAIRCHILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
032557
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129974
PROVISIONAL LICENSE
NY
Enumeration date
08/08/2024
Last updated
09/16/2024
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