Provider Demographics
NPI:1376525063
Name:AFONSO-FEDE, GLORIANE (MD)
Entity Type:Individual
Prefix:
First Name:GLORIANE
Middle Name:
Last Name:AFONSO-FEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1242
Mailing Address - Country:US
Mailing Address - Phone:508-996-3991
Mailing Address - Fax:
Practice Address - Street 1:531 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1242
Practice Address - Country:US
Practice Address - Phone:508-996-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000021180OtherBMCH
TAX ID#Other04-3436165
MA0133515Medicaid
0240214OtherCIGNA
2550884OtherAETNA INSURANCE
MABCBS OF MASSOtherJ23482
0034668OtherNEIGHBORHOOD
MA205012OtherTUFTS HEALTH PLAN
MA205012OtherTUFTS MEDICARE PREFERRED
H37829Medicare UPIN
MAMX8976Medicare PIN