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NPI Code Detail

MEDICARE: LITA MARIA FASANO ED.M.

MEDICARE: LITA MARIA FASANO ED.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist264106MA

General Provider Information

NPI Number : 1225513799
Entity Type Code : Individual
Provider Name (Legal Business Name) : LITA MARIA FASANO ED.M.
Provider Business Mailing Address
First Line : 40 ARMINGTON ST
Second Line :
City : ALLSTON
State : MA
Zip : 02134-2406
Country : US
Telephone Number : 617-635-8534
Fax Number :
Provider Business Practice Location Address
First Line : 40 ARMINGTON ST
Second Line :
City : ALLSTON
State : MA
Zip : 02134-2406
Country : US
Telephone Number : 617-635-8534
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2018
Last Update Date : 10/01/2018

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Directions to “ LITA MARIA FASANO ED.M.” Practice Location

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