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Individual

DR. KENNETH K FUGATE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
525 N MAIN ST, PUNXSUTAWNEY, PA 15767-2581
(814) 938-7933
(814) 938-9872
Mailing address
525 N MAIN ST, PUNXSUTAWNEY, PA 15767-2581
(814) 938-7933
(814) 938-9872

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD039731L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0010556490006
PA
01
003158
BLUE SHIELD INDIVIDUAL #
PA
01
010053900
BLACK LUNG
PA
01
126846
BLUE SHIELD GROUP #
PA
01
211751
UPMC
PA
01
251819235
COMMERICAL INSURANCES
PA
01
251819235001
TRICARE
PA
01
3733
HEALTHEON/HEALTHAMERICA
PA
01
P0000958
GATEWAY
PA
Enumeration date
10/04/2005
Last updated
11/25/2009
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