Provider Demographics
NPI:1851561112
Name:FAIRCLOTH, RUTH S (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:S
Last Name:FAIRCLOTH
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 896263
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6263
Mailing Address - Country:US
Mailing Address - Phone:910-615-4815
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:101 ROBESON ST STE 410
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5520
Practice Address - Country:US
Practice Address - Phone:910-615-1688
Practice Address - Fax:910-321-6254
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24472208000000X
NC2022-015762080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics