Provider Demographics
NPI:1083655450
Name:FAHEY, PATRICIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:E
Last Name:FAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2251
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:
Practice Address - Street 1:19641 E PARKER SQUARE DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-805-2222
Practice Address - Fax:303-805-2255
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080093501OtherRAILROAD MEDICARE
CO01257765Medicaid
CO841033395-01OtherPACIFICARE ID
CO841033395-01OtherPACIFICARE ID
CO01257765Medicaid
COCOA104778Medicare PIN