Provider Demographics
NPI:1114996972
Name:MARCO, TEIG D (MD)
Entity Type:Individual
Prefix:
First Name:TEIG
Middle Name:D
Last Name:MARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9530
Mailing Address - Country:US
Mailing Address - Phone:802-849-2844
Mailing Address - Fax:802-849-2644
Practice Address - Street 1:1199 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9530
Practice Address - Country:US
Practice Address - Phone:802-849-2844
Practice Address - Fax:802-849-2644
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009429Medicaid
E72654Medicare UPIN
VT0009429Medicaid