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General NPI Number Information
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NPI Number | 1831163948
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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 | 02/15/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 104 DELAWARE AVE SUITE 240
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City | UNIONTOWN
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State | PA
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Zip | 15401-3100
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Country | US
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Telephone | 724-434-1655
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Fax | 724-430-3879
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Provider Business Mailing Address
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Address Line | 211 EASY ST
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City | UNIONTOWN
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State | PA
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Zip | 15401-3129
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Country | US
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Telephone | 724-434-1650
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Fax | 724-434-1659
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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 | 724-434-1650
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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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