Provider Demographics
NPI:1649501826
Name:FAYETTE SPECIALTY ASSOCIATES-PULMONARY
Entity type:Organization
Organization Name:FAYETTE SPECIALTY ASSOCIATES-PULMONARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GISANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-434-1650
Mailing Address - Street 1:211 EASY ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-430-5797
Mailing Address - Fax:724-434-1659
Practice Address - Street 1:205 EASY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3128
Practice Address - Country:US
Practice Address - Phone:724-438-5961
Practice Address - Fax:724-438-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty