Provider Demographics
NPI:1508013327
Name:HAYETIAN, FERNANDO D (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:D
Last Name:HAYETIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 UNION AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-671-1161
Mailing Address - Fax:724-671-1170
Practice Address - Street 1:1629 UNION AVE STE 4
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-671-1161
Practice Address - Fax:724-671-1170
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434627208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102203640Medicaid
PA102203640Medicaid