Provider Demographics
NPI:1194880757
Name:FYKE, GEORGE H
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:FYKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BRANDT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6437
Mailing Address - Country:US
Mailing Address - Phone:724-772-5420
Mailing Address - Fax:724-772-5423
Practice Address - Street 1:105 BRANDT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6437
Practice Address - Country:US
Practice Address - Phone:724-772-5420
Practice Address - Fax:724-772-5423
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101933886Medicaid
PA101933886Medicaid