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NPI Code Detail

MEDICARE: THOMAS L. FAZIO M.D.

MEDICARE: THOMAS L. FAZIO M.D.
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
1207RG0100XGastroenterology Physician42754MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2100014711OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13925416OTHERCIGNA HEALTHCARE
30011277OTHERNEIGHBORHOOD HEALTH PLAN
4678816OTHERHEALTHSOURCE
5D11110OTHERMABLUE CROSS BLUE SHIELD
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7975010OTHERNETWORK HEALTH
8A54061OTHERNHANTHEM BLUE CROSS
9042754OTHERMATUFTS HEALTH PLAN
101902800832OTHERMAFALLON COMMUNITY HEALTH PLAN
11MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
1229-00569OTHEREVERCARE
134035145OTHERMAAETNA NON HMO
141902800832OTHERMAAETNA HMO
1530259OTHERMAHARVARD PILGRIM HEALTH CA

General Provider Information

NPI Number : 1902800832
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS L. FAZIO M.D.
Provider Business Mailing Address
First Line : 500 MERRIMACK ST
Second Line : RIVERWALK
City : LAWRENCE
State : MA
Zip : 01843-1756
Country : US
Telephone Number : 978-557-8700
Fax Number : 978-557-8867
Provider Business Practice Location Address
First Line : 500 MERRIMACK ST
Second Line : RIVERWALK
City : LAWRENCE
State : MA
Zip : 01843-1756
Country : US
Telephone Number : 978-557-8700
Fax Number : 978-557-8867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 10/29/2013

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Directions to “ THOMAS L. FAZIO M.D.” Practice Location

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