Provider Demographics
NPI:1609205137
Name:REGINA M FEARMONTI, MD, PA
Entity Type:Organization
Organization Name:REGINA M FEARMONTI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEARMONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-392-9921
Mailing Address - Street 1:17101 LA CANTERA PKWY
Mailing Address - Street 2:6302
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2484
Mailing Address - Country:US
Mailing Address - Phone:713-392-9921
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-616-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4776208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty