Provider Demographics
NPI:1619914587
Name:GARTNER-FANBURG, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GARTNER-FANBURG
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 1:51 SEWALL ST
Mailing Address - Street 2:RHEUMATOLOGY ASSOCIATES, PA
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2643
Mailing Address - Country:US
Mailing Address - Phone:207-774-5761
Mailing Address - Fax:207-874-7478
Practice Address - Street 1:51 SEWALL ST
Practice Address - Street 2:RHEUMATOLOGY ASSOCIATES, PA
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2643
Practice Address - Country:US
Practice Address - Phone:207-774-5761
Practice Address - Fax:207-874-7478
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014882207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF85404Medicare UPIN
MEMM7382Medicare ID - Type Unspecified
MEMM738201Medicare PIN
MEMM738202Medicare PIN