Individual
MILDRED THERESE FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
620 HOWARD AVE, ALTOONA, PA 16601-4804
(814) 942-5000
Mailing address
PO BOX 716, SHARON, PA 16146-0716
(724) 342-5313
(724) 342-5318
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
MD436495
PA
2084P0800X
Psychiatry Physician
Primary
MD436495
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024996330001
—
PA
Enumeration date
05/11/2007
Last updated
07/11/2011
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