Active NPI
Mark Fugate
- Psychologist
- Bradford, PA
National Provider Identifier
1245748334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS017835
- Practice address
- 800 E Main St
Bradford, PA 16701-3278 - Phone
- (814) 817-1400
- Fax
- (814) 362-5245
- NPI assigned
- Jan 11, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS017835 | PA | Primary |
Addresses
Primary practice location
800 E Main St
Bradford, PA 16701-3278
Mailing address
800 E Main St
Bradford, PA 16701-3278
Phone (814) 817-1400
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS017835 | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515628800000",
"number": "1245748334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167013278",
"telephone_number": "814-817-1400",
"fax_number": "814-362-5245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167013278",
"telephone_number": "814-817-1400",
"fax_number": "814-362-5245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUGATE",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-11",
"last_updated": "2018-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS017835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.