Provider Demographics
NPI:1265833230
Name:PETER FAZIO INC
Entity Type:Organization
Organization Name:PETER FAZIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-676-0236
Mailing Address - Street 1:1116A THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-1842
Mailing Address - Country:US
Mailing Address - Phone:215-343-4573
Mailing Address - Fax:
Practice Address - Street 1:1116A THOMAS RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1842
Practice Address - Country:US
Practice Address - Phone:215-343-4573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004353L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0673679000OtherIBC
PA778054OtherBC/BS
PA778054OtherBC/BS
P00184568Medicare PIN