Provider Demographics
NPI:1437184124
Name:FAWCETT, ROBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:FAWCETT
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 1:1001 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3676
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022143E207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20005829OtherAMERIHEALTH MERCY-WMG
PA5882319OtherAETNA
PAP003059OtherGATEWAY-WMG
PA13922OtherGEISINGER
PA257417OtherMAMSI-WMG
PA000605799Medicaid
PA01533302OtherCAPITAL BLUE CROSS-WMG
PA16027OtherJOHNS HOPKINS
PA080131660OtherRAILROAD MEDICARE
PA095042OtherHIGHMARK BLUE SHIELD
PA86528OtherUNISON-WMG (OB)
PA80740OtherUNISON-WMG (PCP)
MD061132800Medicaid
PA30139601OtherAMERIHEALTH MERCY-WMG
PA080131660OtherRAILROAD MEDICARE
PA30139601OtherAMERIHEALTH MERCY-WMG