Healthcare Provider Details

I. General information

NPI: 1871553552
Provider Name (Legal Business Name): DOUGLAS S FUGATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W MAHONING ST SUITE 200
PUNXSUTAWNEY PA
15767-1308
US

IV. Provider business mailing address

120 IRMC DR SUITE160
INDIANA PA
15701-3674
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-0740
  • Fax: 814-938-0750
Mailing address:
  • Phone: 724-465-2676
  • Fax: 724-349-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD034740E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: