MEDICARE: KATIE FUSCO

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
1	207Q00000X	Family Medicine Physician	RN254845	MA

General Provider Information

NPI Number	:	1609575893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE FUSCO

Provider Business Mailing Address
First Line	:	95 POST OFFICE PARK STE 9523
Second Line	:
City	:	WILBRAHAM
State	:	MA
Zip	:	01095-1199
Country	:	US
Telephone Number	:	413-258-0010
Fax Number	:	413-417-2924

Provider Business Practice Location Address
First Line	:	95 POST OFFICE PARK STE 9523
Second Line	:
City	:	WILBRAHAM
State	:	MA
Zip	:	01095-1199
Country	:	US
Telephone Number	:	413-258-0010
Fax Number	:	413-417-2924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/24/2026

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Directions to “ KATIE FUSCO ” Practice Location

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