MEDICARE: EMILY R PATTERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0006X	Clinical Pathology Physician	55421	MN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0101259420	VA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD0000053802	TN

General Provider Information

NPI Number	:	1043506108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY R PATTERSON MD

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W MARKET ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6020
Country	:	US
Telephone Number	:	423-431-1386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	11/02/2017

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