Healthcare Provider Details

I. General information

NPI: 1235193111
Provider Name (Legal Business Name): MARIA D FATIGATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MAPLE LN
BARTON VT
05822-9494
US

IV. Provider business mailing address

46 LAKEMONT RD
NEWPORT VT
05855-9690
US

V. Phone/Fax

Practice location:
  • Phone: 802-754-2112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number420010948
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number042.0010948
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: