Provider Demographics
NPI:1982196002
Name:GUY MICHAEL FASCIANA MD
Entity Type:Organization
Organization Name:GUY MICHAEL FASCIANA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FASCIANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-457-1110
Mailing Address - Street 1:605 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1325
Mailing Address - Country:US
Mailing Address - Phone:570-457-1110
Mailing Address - Fax:570-457-2950
Practice Address - Street 1:605 MAIN ST
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1325
Practice Address - Country:US
Practice Address - Phone:570-457-1110
Practice Address - Fax:570-457-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039471L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty