Healthcare Provider Details

I. General information

NPI: 1790748721
Provider Name (Legal Business Name): MICHELINA FATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELINA FATO-MORTER M.D.

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CENTRE AVE 5TH FLOOR
PITTSBURGH PA
15232-1304
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, N430
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-3351
  • Fax: 412-623-3360
Mailing address:
  • Phone: 412-432-7706
  • Fax: 412-432-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 040123 E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMD 040123 E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD 040123 E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: