Provider Demographics
NPI:1871553552
Name:FUGATE, DOUGLAS S (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:FUGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 IRMC DR
Mailing Address - Street 2:SUITE160
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3674
Mailing Address - Country:US
Mailing Address - Phone:724-465-2676
Mailing Address - Fax:724-349-1830
Practice Address - Street 1:720 W MAHONING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1308
Practice Address - Country:US
Practice Address - Phone:814-938-0740
Practice Address - Fax:814-938-0750
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2016-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD034740E207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI1160OtherRAILROAD MEDICARE
PA0014272070003Medicaid
PA188868Medicare PIN
PAF67045Medicare UPIN