1205824455 NPI number — PATRICE ANN THORNTON MD

Table of content: ANNA WANNEMACHER (NPI 1952765406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205824455 NPI number — PATRICE ANN THORNTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
PATRICE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PASSIDOMO
Provider Other First Name:
PATRICE
Provider Other Middle Name:
THORNTON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205824455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CHAPIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWLING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12564-3337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-855-0084
Provider Business Mailing Address Fax Number:
845-855-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW FAIRFIELD FAMILY PRACTICE
Provider Second Line Business Practice Location Address:
96 ROUTE 37
Provider Business Practice Location Address City Name:
NEW FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-746-6000
Provider Business Practice Location Address Fax Number:
203-746-0511
Provider Enumeration Date:
10/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  175691 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 034751 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01256197 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110232642 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".