Provider Demographics
NPI:1467624361
Name:FAY WEST MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:FAY WEST MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DI LEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-785-7080
Mailing Address - Street 1:127 SIMPSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-8622
Mailing Address - Country:US
Mailing Address - Phone:724-785-7080
Mailing Address - Fax:724-785-5048
Practice Address - Street 1:127 SIMPSON RD STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-8622
Practice Address - Country:US
Practice Address - Phone:724-785-7080
Practice Address - Fax:724-785-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016685F174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28555Medicare UPIN