Provider Demographics
NPI:1063438356
Name:ROBERT M FABER MD PA
Entity type:Organization
Organization Name:ROBERT M FABER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-841-7229
Mailing Address - Street 1:PO BOX 568485
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-8485
Mailing Address - Country:US
Mailing Address - Phone:407-841-7229
Mailing Address - Fax:407-425-8121
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-841-7229
Practice Address - Fax:407-425-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0020632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99934AMedicare ID - Type Unspecified
FLD58371Medicare UPIN