Mary Beth Fasano
Internist Pediatrician Internist - Allergy & Immunology
200 Hawkins Dr
Iowa City
, Iowa 52242-1009
Mary Beth Fasano
Internist Pediatrician Internist - Allergy & Immunology
200 Hawkins Dr
Iowa City
, Iowa 52242-1009
(319) 356-8280
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About
Features
Specialties
- Internist
- Internist - Allergy & Immunology
- Pediatrician
Languages spoken
- English
Location
First Address
- Mary Beth Fasano
- 200 Hawkins Dr
- Iowa City, IA
- Zip : 52242-1009
- Fax : (319) 356-8280
- Phone : (319) 356-3692
Second Address
- Mary Beth Fasano
- 200 Hawkins Dr
- Iowa City, IA
- Zip : 52242-1009
- Fax : (319) 356-8280
- Phone : (319) 356-3692
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | 35451 | IA |
| N | 111NI0900X | Internist | 35451 | IA |
| Y | 207RA0201X | Internist - Allergy & Immunology | 35451 | IA |
| N | 208000000X | Pediatrician | 35451 | IA |
National Provider Identifier
| NPI | 1801884754 |
|---|---|
| Provider Name | Mary Beth Fasano |
| First Address | Iowa City, IA 52242-1009 |
| Second Address | Iowa City, IA 52242-1009 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/10/2005 |
| Last Update Date | 29/11/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 04197 | WELLMARK BCBS (01) | IA |
| 0432013 | (05) | IA |
| F37731 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.