Provider Demographics
NPI:1023022282
Name:FANNING, JAMES B JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:FANNING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:747 WALLINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2914
Mailing Address - Country:US
Mailing Address - Phone:203-699-1637
Mailing Address - Fax:203-284-3161
Practice Address - Street 1:185 CENTER ST
Practice Address - Street 2:SUITE H
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4100
Practice Address - Country:US
Practice Address - Phone:203-284-1060
Practice Address - Fax:203-284-3161
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT034475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG12274Medicare UPIN