Provider Demographics
NPI:1487832861
Name:PATRICK FETTINGER DPM
Entity Type:Organization
Organization Name:PATRICK FETTINGER DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-598-0357
Mailing Address - Street 1:415 MIDDLEBURY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2537
Mailing Address - Country:US
Mailing Address - Phone:203-746-9660
Mailing Address - Fax:203-746-4186
Practice Address - Street 1:415 MIDDLEBURY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2537
Practice Address - Country:US
Practice Address - Phone:203-598-0357
Practice Address - Fax:203-598-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT625332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4140080002Medicare NSC