MEDICARE: DR. RICHARD LOUIS FAIOLA MD

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	XXXXXXXXXX	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6622FA	OTHER	WA	RIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0203077	OTHER	WA	LABOR AND INDUSTRY WA

General Provider Information

NPI Number	:	1689626392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LOUIS FAIOLA MD

Provider Business Mailing Address
First Line	:	4001 HARRISON AVE NW
Second Line	:	STE 101
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5084
Country	:	US
Telephone Number	:	360-704-2362
Fax Number	:	360-350-1445

Provider Business Practice Location Address
First Line	:	4001 HARRISON AVE NW
Second Line	:	STE 101
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5084
Country	:	US
Telephone Number	:	360-704-2362
Fax Number	:	360-350-1445

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/07/2014

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