Samuel Allen Fagenholz
Pediatrician Pediatric Pulmonologist
300 State St Ste 301
Erie
, Pennsylvania 16507-1430
Samuel Allen Fagenholz
Pediatrician Pediatric Pulmonologist
300 State St Ste 301
Erie
, Pennsylvania 16507-1430
(814) 877-6791
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About
Features
Specialties
- Pediatrician
- Pediatric Pulmonologist
Languages spoken
- English
Location
First Address
- Samuel Allen Fagenholz
- 300 State St Ste 301
- Erie, PA
- Zip : 16507-1430
- Fax : (814) 877-6791
- Phone : (814) 877-7907
Second Address
- Samuel Allen Fagenholz
- 300 State St Ste 301
- Erie, PA
- Zip : 16507-1430
- Fax : (814) 877-6791
- Phone : (814) 877-7907
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | MD021621E | PA |
| N | 2080P0214X | Pediatric Pulmonologist | MD021621E | PA |
National Provider Identifier
| NPI | 1376549998 |
|---|---|
| Provider Name | Samuel Allen Fagenholz |
| First Address | Erie, PA 16507-1430 |
| Second Address | Erie, PA 16507-1430 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/06/2005 |
| Last Update Date | 18/03/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| E63542 | (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.