Individual provider · NPI-1

Mary Beth Fasano, MD

Internal Medicine, Allergy & Immunology · Iowa City, IA

NPI number1801884754

StatusActive

Last updated in NPPESNov 29, 2007

Details

NPI: 1801884754
Entity type: Individual (NPI-1)
Name: Mary Beth Fasano
Credential: MD
Sex: Female
Sole proprietor: No
Enumeration date: Oct 13, 2005
Last updated: Nov 29, 2007

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207RA0201X	Internal Medicine, Allergy & Immunology	35451	IA	Yes
207R00000X	Internal Medicine	35451	IA
208000000X	Pediatrics	35451	IA

Practice location

200 Hawkins Dr
Iowa City, IA 52242-1009

Phone 319-356-3692 · Fax 319-356-8280

Mailing address

200 Hawkins Dr
Iowa City, IA 52242-1009

Phone 319-356-3692 · Fax 319-356-8280

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