Healthcare Provider Details

I. General information

NPI: 1205824455
Provider Name (Legal Business Name): PATRICE ANN THORNTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICE THORNTON PASSIDOMO M.D.

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW FAIRFIELD FAMILY PRACTICE 96 ROUTE 37
NEW FAIRFIELD CT
06812
US

IV. Provider business mailing address

7 CHAPIN LN
PAWLING NY
12564-3337
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-6000
  • Fax: 203-746-0511
Mailing address:
  • Phone: 845-855-0084
  • Fax: 845-855-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number175691
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number034751
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: