Healthcare Provider Details

I. General information

NPI: 1740781251
Provider Name (Legal Business Name): ANGELA FOCHESATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HIGH HEAD RD
EAST MACHIAS ME
04630-3856
US

IV. Provider business mailing address

134 HIGH HEAD RD
EAST MACHIAS ME
04630-3856
US

V. Phone/Fax

Practice location:
  • Phone: 207-259-2170
  • Fax:
Mailing address:
  • Phone: 207-259-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3308513
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: