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NPI Code Detail

MEDICARE: DR. PAMELA KAY FADNESS M.D.

MEDICARE: DR. PAMELA KAY FADNESS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician042-0011367VT
22084P0800XPsychiatry PhysicianME134922FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639208846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAMELA KAY FADNESS M.D.
Provider Business Mailing Address
First Line : PO BOX 547
Second Line : ATT: CVMC FINANCE DEPT
City : BARRE
State : VT
Zip : 05641-0547
Country : US
Telephone Number : 802-225-1266
Fax Number : 802-479-3548
Provider Business Practice Location Address
First Line : 713 E MARION AVE STE 139
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33950-3863
Country : US
Telephone Number : 941-833-1750
Fax Number : 941-766-1511
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 09/09/2020

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