Provider Demographics
NPI:1205824455
Name:THORNTON, PATRICE ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ANN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:THORNTON
Other - Last Name:PASSIDOMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7 CHAPIN LN
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-3337
Mailing Address - Country:US
Mailing Address - Phone:845-855-0084
Mailing Address - Fax:845-855-1897
Practice Address - Street 1:NEW FAIRFIELD FAMILY PRACTICE
Practice Address - Street 2:96 ROUTE 37
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812
Practice Address - Country:US
Practice Address - Phone:203-746-6000
Practice Address - Fax:203-746-0511
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175691207R00000X
CT034751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256197Medicaid
110232642OtherMEDICARE RR
NY01256197Medicaid