Provider Demographics
NPI:1871695809
Name:FABIAN, MARY PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1101 W EMMAUS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6676
Mailing Address - Country:US
Mailing Address - Phone:610-797-2000
Mailing Address - Fax:610-791-5814
Practice Address - Street 1:1101 W EMAUS AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6676
Practice Address - Country:US
Practice Address - Phone:610-797-2000
Practice Address - Fax:610-791-5814
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048916L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01191302OtherCAPITAL BLUE CROSS
PA0823350OtherHIGHMARK BLUE SHIELD
PA539725OtherAETNA
PA0340459000OtherKEYSTONE EAST
PA080129699OtherRAILROAD MEDICARE
PA01191302OtherCAPITAL BLUE CROSS
PAG20224Medicare UPIN