Provider Demographics
NPI:1700816782
Name:PANCOAST & FAGERBURG ASSOCIATES
Entity Type:Organization
Organization Name:PANCOAST & FAGERBURG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAGERBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-342-5253
Mailing Address - Street 1:748 QUINCY AVE
Mailing Address - Street 2:SUITE 301B
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1739
Mailing Address - Country:US
Mailing Address - Phone:570-342-5253
Mailing Address - Fax:570-342-6038
Practice Address - Street 1:748 QUINCY AVE
Practice Address - Street 2:SUITE 301B
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1739
Practice Address - Country:US
Practice Address - Phone:570-342-5253
Practice Address - Fax:570-342-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011414420007Medicaid
PA0011414420007Medicaid