Provider Demographics
NPI:1740347194
Name:FAIRCHILD, THOMAS H (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9002 NORTH MERIDIAN STREET
Mailing Address - Street 2:SUITE 222
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5350
Mailing Address - Country:US
Mailing Address - Phone:317-573-4370
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:5255 EAST STOP 11 ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-573-4370
Practice Address - Fax:317-819-0044
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01029453A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN040008969OtherMEDICARE RAILROAD
IN100338660Medicaid
IN100338660Medicaid
IN040008969OtherMEDICARE RAILROAD