Individual
RICHARD DAVID FAIRTILE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 N UNION ST, STE 104, AKRON, OH 44304-1369
(330) 253-9145
(330) 253-6222
Mailing address
190 N UNION ST, STE 104, AKRON, OH 44304-1369
(330) 253-9145
(330) 253-6222
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35-064678 F
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000125730
ANTHEM BCBS IND NUMBER
OH
05
—
0920758
—
OH
01
—
340891295-00
WORKERS COMP GROUP #
OH
05
—
7091249
—
OH
01
—
729890
BUCKEYE COMMUNITY HLTH PL
OH
01
—
CN1092
RAILROAD MEDICARE GROUP #
OH
Enumeration date
04/19/2006
Last updated
07/09/2007
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