Provider Demographics
NPI:1497869226
Name:KING, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:KING
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 1:832 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3513
Mailing Address - Country:US
Mailing Address - Phone:802-862-7705
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3234
Practice Address - Country:US
Practice Address - Phone:802-847-8354
Practice Address - Fax:802-847-6575
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2040Medicaid
VTG96812Medicare UPIN
VTKIVN2040Medicare ID - Type Unspecified