Provider Demographics
NPI:1124269766
Name:FAIRBANKS, DAVID NATHANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NATHANIEL
Last Name:FAIRBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:NATHANIEL FOX
Other - Last Name:FAIRBANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6600 BRADLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3043
Mailing Address - Country:US
Mailing Address - Phone:301-365-1264
Mailing Address - Fax:301-365-5025
Practice Address - Street 1:6600 BRADLEY BLVD.
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3043
Practice Address - Country:US
Practice Address - Phone:301-365-1264
Practice Address - Fax:301-365-5025
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0001515207Y00000X
DCMD25514207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology