Provider Demographics
NPI:1972614014
Name:JOHN A. FABRE, MD PC
Entity Type:Organization
Organization Name:JOHN A. FABRE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FABRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-371-2390
Mailing Address - Street 1:529 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2378
Mailing Address - Country:US
Mailing Address - Phone:814-371-2390
Mailing Address - Fax:814-371-9532
Practice Address - Street 1:529 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2378
Practice Address - Country:US
Practice Address - Phone:814-371-2390
Practice Address - Fax:814-371-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028273E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA342682OtherHIGHMARK
PADH1374OtherRAILROAD MEDICARE
PA1310535OtherUMWA
PA0009047150001Medicaid
PA418318QT5Medicare ID - Type Unspecified
PA060048Medicare ID - Type Unspecified
PA0009047150001Medicaid
PA0793750001Medicare NSC