Provider Demographics
NPI:1336379437
Name:FAUTH, CLARISSA TEGAN (MD)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:TEGAN
Last Name:FAUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF ANATOMIC PATHOLOGY, CHILDREN'S AND WOMEN'
Mailing Address - Street 2:HEALTH CENTRE, 4480 OAK STREET, ROOM L220
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6H 3V4
Mailing Address - Country:CA
Mailing Address - Phone:604-875-2395
Mailing Address - Fax:604-875-3529
Practice Address - Street 1:DEPARTMENT OF ANATOMIC PATHOLOGY, CHILDREN'S AND WOMEN'
Practice Address - Street 2:HEALTH CENTRE, 4480 OAK STREET, ROOM L220
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V6H 3V4
Practice Address - Country:CA
Practice Address - Phone:604-875-2395
Practice Address - Fax:604-875-3529
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ32119207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology