Provider Demographics
NPI:1356313449
Name:FEDERICO, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:FEDERICO
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 1:333 BORTHWICK AVENUE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-559-4111
Mailing Address - Fax:406-752-8220
Practice Address - Street 1:333 BORTHWICK AVENUE
Practice Address - Street 2:SUITE 402
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-559-4111
Practice Address - Fax:406-752-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT41984208G00000X
CT033511208G00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335117Medicaid
CT001335117Medicaid
CT330000123Medicare PIN
CT330000147Medicare PIN