Provider Demographics
NPI:1093704033
Name:FUGE, LADONNA H (MD)
Entity Type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:H
Last Name:FUGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 TERRA COTTA RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15845
Mailing Address - Country:US
Mailing Address - Phone:412-310-0926
Mailing Address - Fax:
Practice Address - Street 1:284 TERRA COTTA RD
Practice Address - Street 2:
Practice Address - City:JOHNSONBURG
Practice Address - State:PA
Practice Address - Zip Code:15845
Practice Address - Country:US
Practice Address - Phone:412-310-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2018-09-27
Deactivation Date:2016-08-22
Deactivation Code:
Reactivation Date:2018-09-10
Provider Licenses
StateLicense IDTaxonomies
PAMD036927E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011284040003Medicaid
PA0011284040003Medicaid
PAP0012165Medicare PIN
PA066583R7RMedicare PIN
PACG1496Medicare PIN