Individual
MARK FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 E MAIN ST, BRADFORD, PA 16701-3278
(814) 817-1400
(814) 362-5245
Mailing address
800 E MAIN ST, BRADFORD, PA 16701-3278
(814) 817-1400
(814) 362-5245
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS017835
PA
Other
Enumeration date
01/11/2018
Last updated
01/11/2018
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