Provider Demographics
NPI:1154439735
Name:FAIRCHILD, THOMAS N (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:N
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1340
Mailing Address - Country:US
Mailing Address - Phone:509-747-7649
Mailing Address - Fax:
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-747-3147
Practice Address - Fax:509-747-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00017789208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8547101Medicaid
WA0151251OtherL&I
WA340018624OtherRRB
WA8547101Medicaid
WA340018624OtherRRB