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NPI Code Detail

MEDICARE: TERRA RENEE FASOLD PA-C

MEDICARE: TERRA RENEE FASOLD PA-C
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
1363A00000XPhysician AssistantMA061949PA

General Provider Information

NPI Number : 1841892619
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRA RENEE FASOLD PA-C
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-6367
Fax Number : 570-271-7142
Provider Business Practice Location Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-9800
Country : US
Telephone Number : 570-271-6367
Fax Number : 570-271-7142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 01/14/2026

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Directions to “ TERRA RENEE FASOLD PA-C” Practice Location

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