Provider Demographics
NPI:1336441146
Name:FAYETTE SPECIALTY ASSOCIATES
Entity Type:Organization
Organization Name:FAYETTE SPECIALTY ASSOCIATES
Other - Org Name:FAYETTE SPECIALTY ASSOCIATES-PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-425-8332
Mailing Address - Street 1:112 YOUNGSTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1344
Mailing Address - Country:US
Mailing Address - Phone:724-425-8332
Mailing Address - Fax:724-434-1659
Practice Address - Street 1:211 EASY ST
Practice Address - Street 2:SUITE 213
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3129
Practice Address - Country:US
Practice Address - Phone:724-425-8332
Practice Address - Fax:724-434-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty