Provider Demographics
NPI:1538105002
Name:FUGATE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FUGATE MEDICAL ASSOCIATES, INC.
Other - Org Name:MYHEALTHCAREMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:814-371-4443
Mailing Address - Street 1:633 MAPLE AVE
Mailing Address - Street 2:PO BOX #348
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2383
Mailing Address - Country:US
Mailing Address - Phone:814-371-4443
Mailing Address - Fax:814-371-5287
Practice Address - Street 1:633 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2383
Practice Address - Country:US
Practice Address - Phone:814-371-4443
Practice Address - Fax:814-371-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031608E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010487980002Medicaid