Provider Demographics
NPI:1801928262
Name:TEIG MARCO DBA FAIRFAX ASSOCIATES IN MEDICINE
Entity type:Organization
Organization Name:TEIG MARCO DBA FAIRFAX ASSOCIATES IN MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:VON LEPEL
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:2007-03-12
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009284Medicaid
VT9284Medicare ID - Type Unspecified