MEDICARE: JAN LOUISE 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	207Q00000X	Family Medicine Physician	251806	NY
2	207Q00000X	Family Medicine Physician	J5862	TX
3	207Q00000X	Family Medicine Physician	38549	NC

General Provider Information

NPI Number	:	1881668523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN LOUISE PATTERSON MD

Provider Business Mailing Address
First Line	:	23 SHEFFIELD DR
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-1849
Country	:	US
Telephone Number	:	518-779-5225
Fax Number	:

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

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	08/13/2014

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