MEDICARE: JAN PATTERSON MD PC

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	2518061	NY

General Provider Information

NPI Number	:	1629400965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAN PATTERSON MD PC

Provider Business Mailing Address
First Line	:	1764 ROUTE 9 UNIT 867
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-9345
Country	:	US
Telephone Number	:	517-779-5225
Fax Number	:	518-288-2848

Provider Business Practice Location Address
First Line	:	242 S CENTRAL AVE
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-3522
Country	:	US
Telephone Number	:	517-779-5225
Fax Number	:	518-288-2848

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAN L PATTERSON
Credential	:	MD
Telephone Number	:	518-779-5225

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	08/08/2013

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