Provider Demographics
NPI:1316933716
Name:FATUR, LEO MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:MATTHEW
Last Name:FATUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1962
Mailing Address - Country:US
Mailing Address - Phone:412-221-1900
Mailing Address - Fax:412-257-1840
Practice Address - Street 1:424 SHADY AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1962
Practice Address - Country:US
Practice Address - Phone:412-221-1900
Practice Address - Fax:412-257-1840
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-12-09
Deactivation Date:2010-02-09
Deactivation Code:
Reactivation Date:2010-12-09
Provider Licenses
StateLicense IDTaxonomies
PAMD19424E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA118529Medicare ID - Type Unspecified
B37096Medicare UPIN