MEDICARE: DR. EDGAR CECIL FEARNOW III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD052054L	PA
2	2085R0204X	Vascular & Interventional Radiology Physician	MD052054L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23-3102793	OTHER	PA	TAX ID - LANCASTER PET IMAGING
2	231855378	OTHER	PA	TAX ID - LANC RADIOLOGY
3	33-1011386	OTHER	PA	TAX ID - MRI GROUP

General Provider Information

NPI Number	:	1174526297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR CECIL FEARNOW III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4216
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17604-4216
Country	:	US
Telephone Number	:	717-394-6028
Fax Number	:	717-394-9223

Provider Business Practice Location Address
First Line	:	555 N DUKE ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2250
Country	:	US
Telephone Number	:	717-394-9223
Fax Number	:	717-394-9223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/01/2023

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