| Doctor Name: | DR. NICHOLAS CHARLES FASANO |
| NPI Number: | 1013932292 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD428992 |
| Business Practice Address: | 1020 Thompson St Jersey Shore, PA - 177401729 |
| Business Phone Number: | 5703985158 |
| Business Fax Number: | |
| Mailing Address: | 302 N 3rd St, LEWISBURG |
| State: | PA |
| Postal Code: | 178371102 |
| Phone Number: | 5707687985 |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 02/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | MD428992 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |