Healthcare Provider Details

I. General information

NPI: 1225148653
Provider Name (Legal Business Name): JAMES K FUGATE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W SWARTZVILLE RD
REINHOLDS PA
17569-9641
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-484-4347
  • Fax: 717-484-0968
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD053184-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0014783040001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier417574
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: