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General NPI Number Information
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NPI Number | 1023223351
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Entity Type | Individual
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Provider Name | MILDRED THERESE FAJARDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 620 HOWARD AVE
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City | ALTOONA
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State | PA
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Zip | 16601-4804
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Country | US
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Telephone | 814-942-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 716
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City | SHARON
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State | PA
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Zip | 16146-0716
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Country | US
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Telephone | 724-342-5313
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Fax | 724-342-5318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD436495
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | MD436495
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License Number State | PA
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