Provider Demographics
NPI:1851673172
Name:FAYETTE EAR, NOSE, THROAT AND ALLERGY PC
Entity Type:Organization
Organization Name:FAYETTE EAR, NOSE, THROAT AND ALLERGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADARAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-430-0310
Mailing Address - Street 1:160 WAYLAND SMITH DR STE 204
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-7500
Mailing Address - Country:US
Mailing Address - Phone:724-430-0310
Mailing Address - Fax:724-430-0314
Practice Address - Street 1:110 DANIEL DR STE 14
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8002
Practice Address - Country:US
Practice Address - Phone:724-430-0310
Practice Address - Fax:724-430-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073010L207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty