Healthcare Provider Details

I. General information

NPI: 1821114539
Provider Name (Legal Business Name): JULIE PATTERSON FAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1037 CHRISTIAN HL
BETHEL VT
05032-9796
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 802-234-6507
  • Fax: 802-234-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number9224
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: