MEDICARE: MARGALY FEDE RN/CRTT/MDS/RAC-CT

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	163W00000X	Registered Nurse	216491	MA
2	171M00000X	Case Manager/Care Coordinator	216491	MA

General Provider Information

NPI Number	:	1588089767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGALY FEDE RN/CRTT/MDS/RAC-CT

Provider Business Mailing Address
First Line	:	135 NEW HAVEN ST
Second Line	:	NA
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-5708
Country	:	US
Telephone Number	:	617-943-7774
Fax Number	:	617-690-0127

Provider Business Practice Location Address
First Line	:	135 NEW HAVEN ST
Second Line	:	NA
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-5708
Country	:	US
Telephone Number	:	617-943-7774
Fax Number	:

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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