Individual
DR. JONATHAN T FAIRBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE, DEPT. OF RADIOLOGY, BURLINGTON, VT 05401-1473
(802) 847-3592
(802) 847-4822
Mailing address
283 SPEAR ST, CHARLOTTE, VT 05445-9132
(802) 847-3592
(802) 847-4822
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
042-0003761
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4755
—
VT
Enumeration date
07/21/2006
Last updated
07/08/2007
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