Organization · NPI-2

Fairhaven Family Medicine

Family Medicine · Burlington, WA

NPI number1215041637
StatusActive
Last updated in NPPESJan 7, 2009

Details

NPI
1215041637
Entity type
Organization (NPI-2)
Legal business name
Fairhaven Family Medicine
Organization subpart
No
Enumeration date
Aug 19, 2006
Last updated
Jan 7, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineMD00023548WAYes
207Q00000X Family MedicineMD00013642WA

Practice location

1030 East Fairhaven Avenue
Burlington, WA 98233

Phone 360-755-0311 · Fax 360-755-1272

Mailing address

Po Box 468
Burlington, WA 98233

Phone 360-755-0311 · Fax 360-755-1272

Authorized official

Stephen M Aldrich
MD
3607550311

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