Provider Demographics
NPI:1952301368
Name:FAYETTE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FAYETTE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-425-8317
Mailing Address - Street 1:112 YOUNGSTOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1344
Mailing Address - Country:US
Mailing Address - Phone:724-432-5831
Mailing Address - Fax:724-425-8326
Practice Address - Street 1:112 YOUNGSTOWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1344
Practice Address - Country:US
Practice Address - Phone:724-432-5831
Practice Address - Fax:724-425-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015441410020Medicaid
PA4441OtherUPMC
PA782000OtherHIGHMARK
PACC8758OtherRAILROAD MEDICARE
PA782000Medicare ID - Type Unspecified