Individual
MR. MARCUS A FANNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
5820 CENTRE AVE, PITTSBURGH, PA 15206-3710
(412) 661-5500
(412) 661-4760
Mailing address
5820 CENTRE AVE, PITTSBURGH, PA 15206-3710
(412) 661-5500
(412) 661-4760
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA002212L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA002212L
MEDICAL LICENSE
PA
Enumeration date
06/26/2006
Last updated
09/30/2008
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