Healthcare Provider Details

I. General information

NPI: 1356313449
Provider Name (Legal Business Name): JOHN ANTHONY FEDERICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVENUE SUITE 402
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

333 BORTHWICK AVENUE SUITE 402
PORTSMOUTH NH
03801
US

V. Phone/Fax

Practice location:
  • Phone: 603-559-4111
  • Fax: 406-752-8220
Mailing address:
  • Phone: 603-559-4111
  • Fax: 406-752-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number033511
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number033511
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number41984
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: