Active NPI
Lisa Fazalare, M.S., CCC-A
- Audiologist
- Clarksburg, WV
National Provider Identifier
1144258674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- A-0111
- Practice address
- 1 Medical Center Drive
Clarksburg, WV 26301 - Phone
- (304) 623-3461
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | A-0111 | WV | Primary |
Addresses
Primary practice location
1 Medical Center Drive
Clarksburg, WV 26301
Mailing address
19 Benton LN
Fairmont, WV 26554-8365
Phone (304) 623-3461
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-0111 | WV | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144258674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 BENTON LN",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265548365",
"telephone_number": "304-623-3461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DRIVE",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "26301",
"telephone_number": "304-623-3461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZALARE",
"first_name": "LISA",
"credential": "M.S., CCC-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "WV",
"license": "A-0111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.