Provider Demographics
NPI:1457410383
Name:PATRICK G FAIRCHILD MD PA
Entity Type:Organization
Organization Name:PATRICK G FAIRCHILD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-265-8142
Mailing Address - Street 1:PO BOX 919023
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32791-9023
Mailing Address - Country:US
Mailing Address - Phone:407-265-8142
Mailing Address - Fax:352-404-7723
Practice Address - Street 1:2020 OAKLEY SEAVER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1902
Practice Address - Country:US
Practice Address - Phone:352-404-7718
Practice Address - Fax:352-404-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261443000Medicaid
FL45538Medicare ID - Type Unspecified