Provider Demographics
NPI:1790748721
Name:FATO, MICHELINA (MD)
Entity Type:Individual
Prefix:
First Name:MICHELINA
Middle Name:
Last Name:FATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELINA
Other - Middle Name:
Other - Last Name:FATO-MORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-7706
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-623-3351
Practice Address - Fax:412-623-3360
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 040123 E207R00000X, 207RA0000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10926491OtherCAQH
PA3982714OtherCIGNA HEALTHCARE
PAFA694437OtherHIGHMARK
PA252370OtherUPMC HEALTH PLAN
PAFA694437OtherPA BLUE CROSS/BLUE SHIELD
PAP00428038OtherRAILROAD MEDICARE
PA215177OtherUNISON HEALTH PLAN
PAP001828OtherGATEWAY HEALTH PLAN
PAFA694437OtherPA BLUE CROSS/BLUE SHIELD
PA215177OtherUNISON HEALTH PLAN