Basic Information
| Provider Information | |||||||||
| NPI: | 1134529340 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FAZIO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 COLCHESTER AVE. | ||||||||
| Address2: | UVM MC - ANESTHESIOLOGY | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472415 | ||||||||
| FaxNumber: | 8028475324 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE. | ||||||||
| Address2: | UVM MC - ANESTHESIOLOGY | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472415 | ||||||||
| FaxNumber: | 8028475324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2014 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant | 367H00000X | 135.0000040 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.