Provider Demographics
NPI:1811990054
Name:FUGATE, JEFFREY STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:FUGATE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S FRONT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2808 OLD POST ROAD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3685
Practice Address - Country:US
Practice Address - Phone:717-920-4400
Practice Address - Fax:717-920-4401
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003906L207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000845786Medicaid
060012835OtherRAILROAD MEDICARE
PA109256Medicare PIN
PAB36786Medicare UPIN