Provider Demographics
NPI:1659345924
Name:FAYETTE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FAYETTE MEDICAL ASSOCIATES INC
Other - Org Name:THE DOCTORS OFFICE MASONTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-425-8317
Mailing Address - Street 1:112 YOUNGSTOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1344
Mailing Address - Country:US
Mailing Address - Phone:724-425-8317
Mailing Address - Fax:724-425-8326
Practice Address - Street 1:2175 MCCLELLANDTOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-2593
Practice Address - Country:US
Practice Address - Phone:724-583-2819
Practice Address - Fax:724-583-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015441410014Medicaid
PA356566OtherHIGHMARK
PA78017OtherUNISON
PAWC06OtherHEALTH AMERICA
PA1038270OtherGATEWAY
PAE034OtherUPMC
PA26024OtherRAILROAD MEDICARE
PA356566OtherHIGHMARK