Provider Demographics
NPI:1851579817
Name:FAYETTE PULMONARY MEDICINE SPECIALISTS,PC
Entity Type:Organization
Organization Name:FAYETTE PULMONARY MEDICINE SPECIALISTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-366-1454
Mailing Address - Street 1:104 DELAWARE AVE
Mailing Address - Street 2:SUITE 246
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3100
Mailing Address - Country:US
Mailing Address - Phone:724-437-4400
Mailing Address - Fax:724-569-1362
Practice Address - Street 1:16 VERNON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4037
Practice Address - Country:US
Practice Address - Phone:419-282-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029340E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty