Provider Demographics
NPI:1548298987
Name:FAIRBANK, JOHN ARTHUR (RPA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ARTHUR
Last Name:FAIRBANK
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 ANTOINETTE CT.
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303
Mailing Address - Country:US
Mailing Address - Phone:518-229-5706
Mailing Address - Fax:
Practice Address - Street 1:760 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3464
Practice Address - Country:US
Practice Address - Phone:518-449-2662
Practice Address - Fax:518-449-1342
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400044245Medicare PIN