Provider Demographics
NPI:1912002676
Name:MARISA FRISCIA MD
Entity Type:Organization
Organization Name:MARISA FRISCIA MD
Other - Org Name:INTERNAL AND WELLNESS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-442-0236
Mailing Address - Street 1:194 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1874
Mailing Address - Country:US
Mailing Address - Phone:802-442-0236
Mailing Address - Fax:802-442-0239
Practice Address - Street 1:194 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1874
Practice Address - Country:US
Practice Address - Phone:802-442-0236
Practice Address - Fax:802-442-0239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL HEALTH & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009307Medicaid
VTVN3074Medicare PIN
VT1009307Medicaid