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General NPI Number Information
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NPI Number | 1659345924
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Entity Type | Organization
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Legal Business Name | FAYETTE MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 2175 MCCLELLANDTOWN RD SUITE 201
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City | MASONTOWN
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State | PA
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Zip | 15461-2593
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Country | US
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Telephone | 724-583-2819
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Fax | 724-583-8550
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Provider Business Mailing Address
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Address Line | 112 YOUNGSTOWN RD SUITE 101
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City | LEMONT FURNACE
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State | PA
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Zip | 15456-1344
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Country | US
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Telephone | 724-425-8317
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Fax | 724-425-8326
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | CHARLENE PULICE
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Credential |
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Telephone | 724-425-8317
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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 |
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License Number State |
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