Provider Demographics
NPI:1437273851
Name:FRED K. FIORAVANTI
Entity Type:Organization
Organization Name:FRED K. FIORAVANTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:FRD
Authorized Official - Middle Name:K
Authorized Official - Last Name:FIORAVANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-352-4448
Mailing Address - Street 1:132 PITTSBURGH ST.
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056
Mailing Address - Country:US
Mailing Address - Phone:724-352-4448
Mailing Address - Fax:724-352-4412
Practice Address - Street 1:132 PITTSBURGH ST.
Practice Address - Street 2:
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056
Practice Address - Country:US
Practice Address - Phone:724-352-4448
Practice Address - Fax:724-352-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA607535Medicare ID - Type UnspecifiedGROUP ID