Healthcare Provider Details

I. General information

NPI: 1710914809
Provider Name (Legal Business Name): KARYN MARIE PATNO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SHERMAN DR ST JOHNSBURY PEDIATRICS
ST JOHNSBURY VT
05819
US

IV. Provider business mailing address

97 SHERMAN DRIVE
ST JOHNSBURY VT
05819
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-5131
  • Fax: 802-748-4237
Mailing address:
  • Phone: 802-748-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420007263
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10506
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12441
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: