Provider Demographics
NPI:1467452896
Name:FAYETTE SPECIALTY ASSOCIATES INC
Entity Type:Organization
Organization Name:FAYETTE SPECIALTY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GISANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-425-8334
Mailing Address - Street 1:211 EASY ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-434-1650
Mailing Address - Fax:724-434-1659
Practice Address - Street 1:211 EASY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3129
Practice Address - Country:US
Practice Address - Phone:724-430-1810
Practice Address - Fax:724-430-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA209772OtherHEALTH AMERICA
PA001462808Medicaid
PA1530427OtherGATEWAY
PA1530427OtherGATEWAY