Provider Demographics
NPI:1285674176
Name:FABRE, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:FABRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-2390
Mailing Address - Fax:814-371-9532
Practice Address - Street 1:865 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2511
Practice Address - Country:US
Practice Address - Phone:814-371-2390
Practice Address - Fax:814-371-9532
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028273E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA180001336OtherRAILROAD MEDICARE
PA0009047150001Medicaid
PA0009047150001Medicaid
PA418318Medicare PIN