Provider Demographics
NPI:1235686098
Name:PATTERSON, MACKENZIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 STRAWBERRY HILL AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2509
Mailing Address - Country:US
Mailing Address - Phone:047-528-9940
Mailing Address - Fax:
Practice Address - Street 1:1 BLACHLEY RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-0002
Practice Address - Country:US
Practice Address - Phone:037-050-7252
Practice Address - Fax:203-705-0915
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06542363AS0400X
NY028282363AS0400X
CT5605363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical