Provider Demographics
NPI:1710961164
Name:FAIRBROTHER, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:FAIRBROTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 WH SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5051
Mailing Address - Country:US
Mailing Address - Phone:252-689-6333
Mailing Address - Fax:252-756-2208
Practice Address - Street 1:1018 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5051
Practice Address - Country:US
Practice Address - Phone:252-689-6333
Practice Address - Fax:252-756-2208
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98012512080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901356Medicaid
NC1396EOtherBCBS NC
NC5901356Medicaid
NCI37238Medicare UPIN