Provider Demographics
NPI:1326015983
Name:FIALLO, VIRIATO MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRIATO
Middle Name:MANUEL
Last Name:FIALLO
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:PO BOX 10417
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-2017
Mailing Address - Country:US
Mailing Address - Phone:413-540-0150
Mailing Address - Fax:413-540-0159
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE # 404
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-736-3163
Practice Address - Fax:413-733-0206
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1704472OtherUNITED HEALTH CARE
J09106OtherBLUE CROSS BLUE SHIELD
2033361OtherAETNA
484559OtherCCARE
MA3054659Medicaid
4848319-004OtherCIGNA
MA12337OtherHEALTH NEW ENGLAND
715050OtherTUFTS HEALTH INSURANCE
801591OtherHAVARD PILGRIM HEALTH CAR
484559OtherCCARE
715050OtherTUFTS HEALTH INSURANCE