MEDICARE: KENNETH PATTERSON M.D.

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	207P00000X	Emergency Medicine Physician	75740	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA75740	OTHER		CDPHP

General Provider Information

NPI Number	:	1427150374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PATTERSON M.D.

Provider Business Mailing Address
First Line	:	29 LEWIS AVE
Second Line	:	FAIRVIEW HOSPITAL EMERGENCY DEPT
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1713
Country	:	US
Telephone Number	:	413-854-9638
Fax Number	:	413-854-9639

Provider Business Practice Location Address
First Line	:	29 LEWIS AVE
Second Line	:	FAIRVIEW HOSPITAL EMERGENCY DEPT
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1713
Country	:	US
Telephone Number	:	413-854-9638
Fax Number	:	413-854-9639

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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