Provider Demographics
NPI:1639149099
Name:FUMIA, FRED DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:DANIEL
Last Name:FUMIA
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 1:19 DAVIS AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:732-776-3797
Mailing Address - Fax:732-776-3796
Practice Address - Street 1:19 DAVIS AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-776-3797
Practice Address - Fax:732-776-3796
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09576100207V00000X
OK21768207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100005610BMedicaid
OK100005610BMedicaid
249401701Medicare ID - Type Unspecified