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General NPI Number Information
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NPI Number | 1851579817
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Entity Type | Organization
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Legal Business Name | FAYETTE PULMONARY MEDICINE SPECIALISTS,PC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 16 VERNON AVE
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City | ASHLAND
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State | OH
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Zip | 44805-4037
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Country | US
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Telephone | 419-282-9440
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Fax |
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Provider Business Mailing Address
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Address Line | 104 DELAWARE AVE SUITE 246
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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 | 724-437-4400
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Fax | 724-569-1362
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES ROBERT POWELL
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Credential | MD
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Telephone | 724-366-1454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD029340E
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License Number State | PA
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