Provider Demographics
NPI:1538137070
Name:FAUSNAUGHT, TODD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WAYNE
Last Name:FAUSNAUGHT
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:549 FAIR ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1419
Practice Address - Country:US
Practice Address - Phone:570-387-2055
Practice Address - Fax:570-387-2056
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420382207Q00000X, 207QA0401X
VA0101267603207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6528OtherGEISINGER HEALTH PLAN
PA816892OtherFIRST PRIORITY HEALTH
PA0018752330005Medicaid
PA002616OtherFIRST PRIORITY HEALTH
PA7379443OtherAETNA
PA0018752330004Medicaid
PA1470448OtherHIGHMARK BLUE SHIELD
PA0018752330006Medicaid
PAH80482OtherHEALTHAMERICA
PA2517565OtherUNITEDHEALTHCARE
PAH80482OtherHEALTHAMERICA
PA6528OtherGEISINGER HEALTH PLAN