Provider Demographics
NPI:1770578015
Name:ESTRADA, FERNANDO PARAYNO (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:PARAYNO
Last Name:ESTRADA
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 1:701 OSTRUM ST
Mailing Address - Street 2:STE 504
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-867-2371
Mailing Address - Fax:610-868-7889
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 504
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-867-2371
Practice Address - Fax:610-868-7889
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036988L208600000X
CAA35269208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001267239Medicaid
PA001267239Medicaid
155987Medicare ID - Type Unspecified