Provider Demographics
NPI:1679012025
Name:KAREN J FAHEY MD
Entity Type:Organization
Organization Name:KAREN J FAHEY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-200-2144
Mailing Address - Street 1:205 15TH AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 15TH AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7873
Practice Address - Country:US
Practice Address - Phone:253-200-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty