Basic Information
| Provider Information | |||||||||
| NPI: | 1982196002 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUY MICHAEL FASCIANA MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DURYEA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186421325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704571110 | ||||||||
| FaxNumber: | 5704572950 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DURYEA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186421325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704571110 | ||||||||
| FaxNumber: | 5704572950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | FASCIANA | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5704571110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD039471L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.