MEDICARE: DR. KATHLEEN ALICE FORTNER 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	2084P0800X	Psychiatry Physician	148182	NY

General Provider Information

NPI Number	:	1447205992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN ALICE FORTNER M.D.

Provider Business Mailing Address
First Line	:	15 EMERSON AVE
Second Line	:
City	:	CROTON ON HUDSON
State	:	NY
Zip	:	10520-2720
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-788-4295

Provider Business Practice Location Address
First Line	:	100 ALBANY POST RD
Second Line	:	VA HUDSON VALLEY HEALTH CARE SYSTEM
City	:	MONTROSE
State	:	NY
Zip	:	10548-1415
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-788-4295

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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