Healthcare Provider Details

I. General information

NPI: 1174600613
Provider Name (Legal Business Name): PATRICK J TANGNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/25/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DR STE 307
BENNINGTON VT
05201-5018
US

IV. Provider business mailing address

54 RIVER RIDGE DR. PROFESSIONAL OFFICE
DAYTON ME
04005
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-4555
  • Fax: 802-440-6087
Mailing address:
  • Phone: 207-205-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number15779
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD13411
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: