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General NPI Number Information
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NPI Number | 1790842110
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Entity Type | Individual
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Provider Name | NAOMI K FUKAGAWA M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | UNIVERSITY OF VERMONT 89 BEAUMONT AVENUE, GIVEN BUILDING C-207
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City | BURLINGTON
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State | VT
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Zip | 05405-0001
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Country | US
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Telephone | 802-656-4403
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 PHEASANT HILL RD
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City | SHELBURNE
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State | VT
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Zip | 05482-7745
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Country | US
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Telephone | 802-985-5495
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 48073
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License Number State | MA
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