Provider Demographics
NPI:1285683409
Name:FAIRCHILD, EMILY S (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:S
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8769
Mailing Address - Fax:410-328-3577
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8769
Practice Address - Fax:410-328-3577
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329751900Medicaid
MD523962-03 & 01OtherBLUE CROSS/BLUE SHIELD
MDB69423Medicare UPIN
MD329751900Medicaid
MDS085E483Medicare PIN