Healthcare Provider Details

I. General information

NPI: 1831168798
Provider Name (Legal Business Name): DANA M FANNING PA-C, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA M HOTCHKISS

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 POND PARK RD SUITE 102
HINGHAM MA
02043-4347
US

IV. Provider business mailing address

2 POND PARK RD SUITE 102
HINGHAM MA
02043-4347
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-5555
  • Fax: 781-335-6047
Mailing address:
  • Phone: 781-337-5555
  • Fax: 781-335-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAP2410
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: