Active NPI
Teig D Marco, M.D.
- Internal Medicine Physician
- Fairfax, VT
National Provider Identifier
1114996972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0420007992
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009429 | Medicaid | VT |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 0420007992 | VT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New 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.
-
- General Acute Care Hospital
- Saint Albans, VT
- NPI 1063546984
-
- Internal Medicine Physician
- Fairfax, VT
- NPI 1801928262
Internal Medicine
-
- Family Medicine Physician
- Alburg, VT
- NPI 1407843543
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.