1093812802 NPI number — MR. STEPHEN F FETSKO

Table of content: MR. STEPHEN F FETSKO (NPI 1093812802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093812802 NPI number — MR. STEPHEN F FETSKO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETSKO
Provider First Name:
STEPHEN
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093812802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 OLD NATIONAL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15333-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-632-6801
Provider Business Mailing Address Fax Number:
734-632-6312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAELS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15320-1325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-966-5081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007288440093 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 328834A764918 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com