1306915681 NPI number — TERESA KATHLEEN FITZHARRIS-ONYON MD

Table of content: TERESA KATHLEEN FITZHARRIS-ONYON MD (NPI 1306915681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306915681 NPI number — TERESA KATHLEEN FITZHARRIS-ONYON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZHARRIS-ONYON
Provider First Name:
TERESA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306915681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTERFIELD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-256-6780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 BELMONT AVE
Provider Second Line Business Practice Location Address:
BRATTLEBORO EMERGENCY SERVICES INC
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-257-8382
Provider Business Practice Location Address Fax Number:
802-251-8466
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  0420008912 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0VN0832 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19603 . This is a "VT BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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