Basic Information
| Provider Information | |||||||||
| NPI: | 1558309666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAIZON | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD424031 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 001594593 | 01 | PA | HIGHMARK | OTHER | 000000152936 | 01 | PA | UNISON | OTHER | 1416527 | 01 | PA | AETNA-HMO | OTHER | 100901618 0002 | 05 | PA | MEDICAID | 2272089000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 50056055 | 01 | PA | KEYSTONE HEALTH PLAN CENTRAL | OTHER | 20033756 | 01 | PA | MERCY | OTHER | 1539392 | 01 | PA | GATEWAY | OTHER | 50056055 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 7113657 | 01 | PA | AETNA-NON HMO | OTHER |