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General NPI Number Information
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NPI Number | 1558426452
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Entity Type | Individual
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Provider Name | RONALD P FETSKO PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 4186 CORTLAND DR BOX 367
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City | NEW PARIS
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State | PA
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Zip | 15554-7706
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Country | US
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Telephone | 814-839-4108
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Fax | 814-839-4845
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Provider Business Mailing Address
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Address Line | 1086 FRANKLIN ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-410-8300
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Fax | 814-410-8331
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA000268L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA002202
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License Number State | PA
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