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Organization

KENNETH K. FUGATE, M.D.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KENNETH K FUGATE MD (OWNER)
(814) 938-7933
Entity
Organization

Contact information

Practice address
525 N MAIN ST, PUNXSUTAWNEY, PA 15767-2581
(814) 938-7933
(814) 938-3299
Mailing address
525 N MAIN ST, PUNXSUTAWNEY, PA 15767-2581
(814) 938-7933
(814) 938-3299

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
126846
BLUE SHIELD GROUP #
PA
Enumeration date
06/06/2006
Last updated
11/25/2009
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