MEDICARE: MS. DANA M FANNING PA-C, PT

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
1	225100000X	Physical Therapist	15029	MA
2	363A00000X	Physician Assistant	AP2410	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99510	OTHER	MA	FALLON

General Provider Information

NPI Number	:	1831168798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA M FANNING PA-C, PT

Provider Business Mailing Address
First Line	:	2 POND PARK RD
Second Line	:	SUITE 102
City	:	HINGHAM
State	:	MA
Zip	:	02043-4347
Country	:	US
Telephone Number	:	781-337-5555
Fax Number	:	781-335-6047

Provider Business Practice Location Address
First Line	:	2 POND PARK RD
Second Line	:	SUITE 102
City	:	HINGHAM
State	:	MA
Zip	:	02043-4347
Country	:	US
Telephone Number	:	781-337-5555
Fax Number	:	781-335-6047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/16/2014

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