Provider Demographics
NPI:1235160862
Name:FAHY, EDWARD M (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:FAHY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-1844
Mailing Address - Country:US
Mailing Address - Phone:215-208-2861
Mailing Address - Fax:
Practice Address - Street 1:3160 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1844
Practice Address - Country:US
Practice Address - Phone:215-208-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP82100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50955Medicare UPIN
NJ080533Medicare ID - Type Unspecified