Healthcare Provider Details

I. General information

NPI: 1437823044
Provider Name (Legal Business Name): FAYETTE PHYSICIAN NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAPLE ST
FRIENDSVILLE MD
21531-2122
US

IV. Provider business mailing address

PO BOX 796
MORGANTOWN WV
26507-0796
US

V. Phone/Fax

Practice location:
  • Phone: 301-746-4160
  • Fax: 301-746-4162
Mailing address:
  • Phone: 800-541-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID FREDERICK HESS
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 724-430-5000