Provider Demographics
NPI:1568452886
Name:PATEK, DAVID JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JACKSON
Last Name:PATEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 TOLMAN POND RD
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:NH
Mailing Address - Zip Code:03457-5521
Mailing Address - Country:US
Mailing Address - Phone:603-847-9745
Mailing Address - Fax:
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-257-8363
Practice Address - Fax:802-258-4903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0007486207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0003085Medicaid
VTPAVT9185Medicare ID - Type Unspecified
VT0003085Medicaid