Healthcare Provider Details

I. General information

NPI: 1811086382
Provider Name (Legal Business Name): ROBERT J. FAGIOLETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 TYLER AVE
WASHINGTON PA
15301-3842
US

IV. Provider business mailing address

457 TYLER AVE
WASHINGTON PA
15301-3842
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-7865
  • Fax: 724-228-1987
Mailing address:
  • Phone: 724-225-7865
  • Fax: 724-228-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD011781E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: