Individual
DR. JOSEPH J FAZALARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3500
(681) 342-3507
Mailing address
527 MEDICAL PARK DR STE 400, BRIDGEPORT, WV 26330-9010
(681) 342-3500
(681) 342-3507
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
24001
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810018178
MEDICAID
WV
01
—
4293261
MEDICARE PTAN
WV
Enumeration date
05/30/2008
Last updated
03/07/2023
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