Healthcare Provider Details

I. General information

NPI: 1336672898
Provider Name (Legal Business Name): BRIAN CHRISTOPHER FIDALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-0001
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE INTERNAL MEDICINE RESIDENCY OFFICE, FLOOR 6, CENTER 12
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax: 603-640-1228
Mailing address:
  • Phone: 212-305-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number24115
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: