Provider Demographics
NPI:1730619693
Name:FAJARDO, OLGA (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1348
Practice Address - Country:US
Practice Address - Phone:608-287-2830
Practice Address - Fax:608-890-6797
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82308207VG0400X
PAMT213862207V00000X
TN63190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology