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General NPI Number Information
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NPI Number | 1306843560
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Entity Type | Individual
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Provider Name | FEDERICO E FIALLOS MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2005
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 29 RIDGEWOOD RD
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City | SPRINGFIELD
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State | VT
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Zip | 05156-3050
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Country | US
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Telephone | 802-885-5600
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Fax | 802-885-5605
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Provider Business Mailing Address
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Address Line | 29 RIDGEWOOD RD
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City | SPRINGFIELD
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State | VT
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Zip | 05156-3050
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Country | US
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Telephone | 802-885-5600
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Fax | 802-885-5605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 042-0008032
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License Number State | VT
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