Organization
FAIRHAVEN FAMILY MEDICINE PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN M ALDRICH M.D. (OWNER/PHYSICIAN)
(360) 755-0311
Entity
Organization
Contact information
Practice address
1030 E FAIRHAVEN AVE, BURLINGTON, WA 98233-2006
(360) 755-0311
(360) 755-1272
Mailing address
PO BOX 468, BURLINGTON, WA 98233-0468
(360) 755-0311
(360) 755-1272
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
MD00013642
WA
261QM1300X
Multi-Specialty Clinic/Center
MD00023548
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S57930
REGENCE BLUE SHIELD
WA
Enumeration date
12/05/2008
Last updated
09/15/2010
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