Provider Demographics
NPI:1457399669
Name:FAZIO, GREGORY P (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:FAZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:
Practice Address - Street 1:30 MONUMENT RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5024
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-851-3521
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049453L207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413897OtherUPMC- YH ONLY
PA01332201OtherCBC
PA090501OtherUNISON
PA1521509OtherGATEWAY CDA
PA529895OtherMARYLAND BLUE CROSS BLUE SHIELD
PA001414497Medicaid
PA20007082OtherAMERIHEALTH MERCY CDA
PA00803OtherHIGHMARK BLUE SHIELD
PA060034887OtherRAILROAD MEDICARE
PA38407OtherGEISINGER CDA
F67164Medicare UPIN
PA001414497Medicaid
PA008030Medicare PIN