Individual
DR. DONALD EDWARD FETTEROLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
12 LAUREL HILL RD, MC DONALD, PA 15057-3503
(412) 638-2891
Mailing address
PO BOX 246, IMPERIAL, PA 15126-0246
(412) 638-2891
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD023825-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058175
GA STATE LICENSE NUMBER
GA
01
—
MD023825E
PA STATE LICENSE NUMBER
PA
Enumeration date
12/11/2006
Last updated
06/13/2016
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