Healthcare Provider Details

I. General information

NPI: 1952301368
Provider Name (Legal Business Name): FAYETTE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 YOUNGSTOWN RD SUITE 101
LEMONT FURNACE PA
15456-1344
US

IV. Provider business mailing address

112 YOUNGSTOWN RD SUITE 101
LEMONT FURNACE PA
15456-1344
US

V. Phone/Fax

Practice location:
  • Phone: 724-432-5831
  • Fax: 724-425-8326
Mailing address:
  • Phone: 724-432-5831
  • Fax: 724-425-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLENE PULICE
Title or Position: MEDICAL BILLER
Credential:
Phone: 724-425-8317