MEDICARE: DR. LORETTA L PATTONGREENIDGE 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	207Q00000X	Family Medicine Physician	145509	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	145509	OTHER	NY	MEDICAL LICENSE #

General Provider Information

NPI Number	:	1477610889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORETTA L PATTONGREENIDGE M.D

Provider Business Mailing Address
First Line	:	PO BOX 26246
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-6246
Country	:	US
Telephone Number	:	718-604-5574
Fax Number	:	718-604-5527

Provider Business Practice Location Address
First Line	:	333 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3601
Country	:	US
Telephone Number	:	718-381-5600
Fax Number	:	718-456-1068

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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