=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174600613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK J TANGNEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 03/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 HOSPITAL DR STE 307
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05201-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-447-4555
-----------------------------------------------------
Fax | 802-440-6087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 RIVER RIDGE DR. PROFESSIONAL OFFICE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-205-9958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 15779
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | MD13411
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------