NICHOLAS FASANO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036147019

License Status

NOT RENEWED

Business

Title

First Name

NICHOLAS

Last Name

FASANO

Business Name

NICHOLAS FASANO MD

Original Issue Date

07/25/2018

Effective Date

07/25/2018

Expiration Date

09/30/2020

City

SPRING GROVE

State

Zip

17362

Ever Disciplined

LastModifiedDate

01/14/2021