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1013932292

NPI Code Detail

MEDICARE: NICHOLAS CHARLES FASANO MD

MEDICARE: NICHOLAS CHARLES FASANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	1018905	MA
2	2085R0202X	Diagnostic Radiology Physician	MD428992	PA
3	2085R0202X	Diagnostic Radiology Physician	D0087818	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013932292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS CHARLES FASANO MD

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:	800-225-8885
Fax Number	:	508-334-1977

Provider Business Practice Location Address
First Line	:	55 LAKE AVE NORTH
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01655-0002
Country	:	US
Telephone Number	:	508-334-3850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/29/2026

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Directions to “ NICHOLAS CHARLES FASANO MD” Practice Location

Language	Start Address	Practice Location

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