MEDICARE: DR. JOSEPH JAMES FAMMARTINO M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD2006-0840	NM
2	207W00000X	Ophthalmology Physician	MD60275755	WA
3	207W00000X	Ophthalmology Physician	35040894	OH
4	207W00000X	Ophthalmology Physician	MD040856E	PA

#	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

NPI Number	:	1528061876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JAMES FAMMARTINO M.D.

Provider Business Mailing Address
First Line	:	9800 LEVIN RD NW STE 203
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-7849
Country	:	US
Telephone Number	:	360-307-0300
Fax Number	:	360-307-0302

Provider Business Practice Location Address
First Line	:	4676 DOUGLAS CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3619
Country	:	US
Telephone Number	:	330-494-1116
Fax Number	:	330-494-0276

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/15/2019

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax: