Individual
MICHAEL FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
703 RUTTER AVE, KINGSTON, PA 18704-4801
(570) 288-7405
(570) 288-7406
Mailing address
2661 RIVA RD STE 1030, ANNAPOLIS, MD 21401-7131
(667) 354-5528
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS022889
PA
Other
Enumeration date
05/21/2019
Last updated
03/21/2026
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