Provider Demographics
NPI:1639706807
Name:FAJGENBAUM, KRISTEN DIANNA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:DIANNA
Last Name:FAJGENBAUM
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 1:2301 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4908
Mailing Address - Country:US
Mailing Address - Phone:615-327-9797
Mailing Address - Fax:615-613-0329
Practice Address - Street 1:2301 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4908
Practice Address - Country:US
Practice Address - Phone:615-327-9797
Practice Address - Fax:615-613-0329
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70946207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program