MEDICARE: DR. SALLY WOODIE FODERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	167	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306822580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY WOODIE FODERO

Provider Business Mailing Address
First Line	:	PO BOX 286
Second Line	:
City	:	NEW CASTLE
State	:	NH
Zip	:	03854-0286
Country	:	US
Telephone Number	:	603-436-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 PORTSMOUTH AVE
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2264
Country	:	US
Telephone Number	:	603-436-4655
Fax Number	:	603-436-4660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	11/17/2015

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