Provider Demographics
NPI:1891826780
Name:TEIG MARCO
Entity Type:Organization
Organization Name:TEIG MARCO
Other - Org Name:FAIRFAX ASSOCIATES IN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-849-2844
Mailing Address - Street 1:1199 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9530
Mailing Address - Country:US
Mailing Address - Phone:802-849-2844
Mailing Address - Fax:802-849-2644
Practice Address - Street 1:1199 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9530
Practice Address - Country:US
Practice Address - Phone:802-849-2844
Practice Address - Fax:802-849-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020886Medicaid
VT0009429Medicaid
VT9429Medicare ID - Type Unspecified