Organization
FAYETTE OB/GYN, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY A WILSON (BILLER)
(724) 430-6200
Entity
Organization
Contact information
Practice address
404 W MAIN ST, UNIONTOWN, PA 15401-2868
(724) 430-6200
(724) 430-6250
Mailing address
404 W MAIN ST, UNIONTOWN, PA 15401-2868
(724) 430-6200
(724) 430-6250
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015988600001
—
PA
Enumeration date
10/17/2006
Last updated
06/19/2012
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