Individual
DR. MARY C. FAHRENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
96 CAMPUS DRIVE, SUITE 1, SCARBOROUGH, ME 04074
(207) 885-9905
(207) 396-5600
Mailing address
301C US ROUTE ONE, SCARBOROUGH, ME 04074
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD14752
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036238
ANTHEM
—
05
—
296830099
—
ME
05
—
30200169
—
NH
Enumeration date
06/13/2006
Last updated
01/26/2015
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