Provider Demographics
NPI:1790291078
Name:VICENTE T FALGUI MD PC
Entity Type:Organization
Organization Name:VICENTE T FALGUI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FALGUI MD PC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-791-4648
Mailing Address - Street 1:990 MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:24541
Mailing Address - Country:US
Mailing Address - Phone:434-791-4648
Mailing Address - Fax:434-793-2631
Practice Address - Street 1:990 MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-791-4648
Practice Address - Fax:434-793-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006092691Medicaid