Provider Demographics
NPI:1316256514
Name:MENDONCAFEITOSARUIVO, FABIOLA (MD)
Entity type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:
Last Name:MENDONCAFEITOSARUIVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARSTON ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2357
Mailing Address - Country:US
Mailing Address - Phone:978-946-8550
Mailing Address - Fax:978-946-3186
Practice Address - Street 1:2301 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6130
Practice Address - Country:US
Practice Address - Phone:215-886-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055238207R00000X
PAMD480995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine