Individual
SAMUEL ALLEN FAGENHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 STATE ST STE 301, ERIE, PA 16507-1430
(814) 877-7907
(814) 877-6791
Mailing address
300 STATE ST STE 301, ERIE, PA 16507-1430
(814) 877-7907
(814) 877-6791
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD021621E
PA
2080P0214X
Pediatric Pulmonology Physician
MD021621E
PA
Other
Enumeration date
06/28/2005
Last updated
03/18/2013
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