Provider Demographics
NPI:1952780314
Name:FAIRFAX ASSOCIATES IN MEDICINE PLLC
Entity Type:Organization
Organization Name:FAIRFAX ASSOCIATES IN MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VON LEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-849-2844
Mailing Address - Street 1:1199 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9530
Mailing Address - Country:US
Mailing Address - Phone:802-849-2844
Mailing Address - Fax:802-849-2644
Practice Address - Street 1:1199 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9530
Practice Address - Country:US
Practice Address - Phone:802-849-2844
Practice Address - Fax:802-849-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty