Individual
NICHOLAS CHARLES FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE NORTH, WORCESTER, MA 01655-0002
(508) 334-3850
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
1018905
MA
2085R0202X
Diagnostic Radiology Physician
D0087818
MD
2085R0202X
Diagnostic Radiology Physician
Primary
MD428992
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072163821
—
DC
05
—
1017198590001
—
PA
05
—
887303800
—
MD
Enumeration date
07/12/2006
Last updated
01/29/2026
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