| Michael E Fath, D.o., P.c | |
|
575 Pierce St Ste 101 Kingston PA 18704-5700 | |
| (570) 718-8676 | |
| (570) 338-2345 |
| Full Name | Michael E Fath, D.o., P.c |
|---|---|
| Speciality | Family Medicine |
| Location | 575 Pierce St Ste 101, Kingston, Pennsylvania |
| Authorized Official Name and Position | Michael E Fath (CEO/PRESIDENT) |
| Authorized Official Contact | 5707188676 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael E Fath, D.o., P.c 575 Pierce St Ste 101 Kingston PA 18704-5700 Ph: (570) 338-2345 | Michael E Fath, D.o., P.c 575 Pierce St Ste 101 Kingston PA 18704-5700 Ph: (570) 718-8676 |
| NPI Number | 1801067145 |
|---|---|
| Provider Enumeration Date | 03/14/2008 |
| Last Update Date | 01/22/2021 |
| Medicare PECOS PAC ID | 7416033006 |
|---|---|
| Medicare Enrollment ID | O20080324000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801067145 | NPI | - | NPPES |
| 1038359820001 | Medicaid | PA | |
| 4505879 | Other | HIGHMRK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS012073 (Pennsylvania) | Primary |
| Provider Name | Michael E Fath |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487631214 PECOS PAC ID: 9335043009 Enrollment ID: I20031124000566 |
| Provider Name | Michael F Robatin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649273574 PECOS PAC ID: 3274563838 Enrollment ID: I20050817000026 |
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