Individual
MARIA MABEL FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 HOSPITAL DR, LEWISBURG, PA 17837-9314
(570) 522-4110
(570) 768-3911
Mailing address
1 HOSPITAL DR STE 306, LEWISBURG, PA 17837-9350
(570) 522-4110
(570) 768-3911
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
Primary
MD067300L
PA
207ZC0500X
Cytopathology Physician
MD067300L
PA
207ZP0101X
Anatomic Pathology Physician
MD067300L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17314940004
—
PA
01
—
220025023
RAILROAD MEDICARE
PA
01
—
232809429
TRICARE
PA
01
—
321847
HEALTH AMERICA
PA
01
—
540643
BLUE SHIELD
PA
Enumeration date
07/20/2006
Last updated
05/24/2022
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