Fazalare, Joseph J
Fazalare, Joseph J is an sole proprietor health care provider with primary practice located at 527 Medical Park Dr Ste 400 , Bridgeport WV 26330-9010. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Fazalare, Joseph J can be contacted via phone (681) 342-3500.Contact Information
Primary practice address
527 Medical Park Dr Ste 400
Bridgeport WV 26330-9010
Phone: (681) 342-3500
Fax: (681) 342-3507
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | 24001 | West Virginia |
Profile Details
| NPI number | 1336307941 |
|---|---|
| LBN Legal business name | Fazalare, Joseph J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 30th, 2008 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336307941 | NPPES |
| West Virginia | Other | 4293261 | MEDICARE PTAN |
| West Virginia | Other | 3810018178 | MEDICARE PTAN |
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