Individual provider Active NPI

Teig D Marco, M.D.

  • Internal Medicine Physician
  • Fairfax, VT
National Provider Identifier
1114996972
Registry record updated Feb 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0420007992 Issued in VT
Practice address
1199 Main St
Fairfax, VT 05454-9530
Phone
(802) 849-2844
Fax
(802) 849-2644
NPI assigned
Mar 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0420007992 VT Primary

Addresses

Primary practice location

1199 Main St
Fairfax, VT 05454-9530

Mailing address

1199 Main St
Fairfax, VT 05454-9530
Phone (802) 849-2844

Other identifiers 1

IdentifierTypeStateIssuer
0009429MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040729001054 VT Practitioner - Internal Medicine 0749250462 Reassigns benefits to 1 organization
Practice locations: Fairfax, VT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0420007992VTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Center, Inc. Current Accepting new patients
Teig Marco Dba Fairfax Associates in Medicine Internal Medicine Past Accepting new patients
The Richford Health Center Inc Past Accepting new patients

Locations

133 Fairfield St
Saint Albans, VT 05478
Phone (802) 524-1227

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297987200000",
    "number": "1114996972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 MAIN ST",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054549530",
            "telephone_number": "802-849-2844",
            "fax_number": "802-849-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 MAIN ST",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054549530",
            "telephone_number": "802-849-2844",
            "fax_number": "802-849-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCO",
        "first_name": "TEIG",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2011-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "0420007992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009429",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VT

Sources for this page

Verify at the official NPI Registry.