Provider Demographics
NPI:1093132912
Name:FADEN, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:FADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W BROAD ST STE 506
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5779
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:610-954-5480
Practice Address - Street 1:1 W BROAD ST STE 506
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5779
Practice Address - Country:US
Practice Address - Phone:610-954-5810
Practice Address - Fax:610-954-5480
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11008400207L00000X
VA0101263555207L00000X
PAMD472456207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093132912Medicaid
WV1093132912Medicaid