Healthcare Provider Details

I. General information

NPI: 1275258782
Provider Name (Legal Business Name): PATRICK FAHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SOUTHSIDE RD
YORK ME
03909-5117
US

IV. Provider business mailing address

36 JOSIAH NORTON RD
CAPE NEDDICK ME
03902-7930
US

V. Phone/Fax

Practice location:
  • Phone: 978-238-9268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: