Individual
JONATHAN T FANBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 BUCKNAM ROAD, SUITE 1D, FALMOUTH, ME 04105-1208
(207) 781-1775
(207) 781-1780
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MD14878
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282610099
—
ME
Enumeration date
06/09/2006
Last updated
06/26/2012
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