| Fairfield Family Practice Pc | |
|
1300 Sheridan Street Suite 1 Williamsport PA 17701 | |
| (570) 601-6202 | |
| (570) 368-2064 |
| Full Name | Fairfield Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Sheridan Street, Williamsport, Pennsylvania |
| Authorized Official Name and Position | John A Pellegrino (PHYSICIAN) |
| Authorized Official Contact | 5703682002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfield Family Practice Pc 1300 Sheridan Street Suite 1 Williamsport PA 17701 Ph: (570) 601-6202 | Fairfield Family Practice Pc 1300 Sheridan Street Suite 1 Williamsport PA 17701 Ph: (570) 601-6202 |
| NPI Number | 1952409898 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952409898 | NPI | - | NPPES |
| 0075301990002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | DS008076L (Pennsylvania) | Primary |
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