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General NPI Number Information
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NPI Number | 1801067145
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Entity Type | Organization
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Legal Business Name | MICHAEL E FATH, D.O., P.C
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 575 PIERCE ST STE 101
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City | KINGSTON
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State | PA
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Zip | 18704-5700
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Country | US
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Telephone | 570-718-8676
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Fax | 570-338-2345
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Provider Business Mailing Address
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Address Line | 575 PIERCE ST STE 101
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City | KINGSTON
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State | PA
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Zip | 18704-5700
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Country | US
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Telephone | 570-338-2345
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Fax | 570-718-8676
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MICHAEL E FATH
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Credential | D.O.
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Telephone | 570-718-8676
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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 | OS012073
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License Number State | PA
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