Healthcare Provider Details

I. General information

NPI: 1689626392
Provider Name (Legal Business Name): RICHARD LOUIS FAIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 HARRISON AVE NW STE 101
OLYMPIA WA
98502-5084
US

IV. Provider business mailing address

4001 HARRISON AVE NW STE 101
OLYMPIA WA
98502-5084
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-2362
  • Fax: 360-350-1445
Mailing address:
  • Phone: 360-704-2362
  • Fax: 360-350-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberXXXXXXXXXX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: