Provider Demographics
NPI:1609959188
Name:FAIRFIELD MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:FAIRFIELD MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-377-2156
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:33 RED HILL ROAD
Mailing Address - City:FAIRFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24435-0405
Mailing Address - Country:US
Mailing Address - Phone:540-377-2156
Mailing Address - Fax:540-377-9476
Practice Address - Street 1:33 RED HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:VA
Practice Address - Zip Code:24435-0405
Practice Address - Country:US
Practice Address - Phone:540-377-2156
Practice Address - Fax:540-377-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7610025Medicaid
VA080005979Medicare Oscar/Certification
PA493807Medicare PIN
VA7610025Medicaid