Individual
MICHAEL CHARLES FAJGENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3410 EXECUTIVE DR, SUITE 103, RALEIGH, NC 27609-7450
(919) 872-5296
(919) 850-9718
Mailing address
3410 EXECUTIVE DR, SUITE 103, RALEIGH, NC 27609-7450
(919) 872-5296
(919) 850-9718
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
32359
NC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
32359
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8931094
—
NC
Enumeration date
01/28/2006
Last updated
11/11/2015
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