Provider Demographics
NPI:1376660977
Name:FAMA, TERESA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:FAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER INC-FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-1750
Mailing Address - Fax:802-225-1733
Practice Address - Street 1:130 FISHER ROAD
Practice Address - Street 2:MOB-B SUITE 2-3
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9522
Practice Address - Country:US
Practice Address - Phone:802-225-1750
Practice Address - Fax:802-225-1733
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0420011411207RR0500X
VT060-0002965390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014060Medicaid
VT000228401Medicare PIN