Provider Demographics
NPI:1710914809
Name:PATNO, KARYN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:MARIE
Last Name:PATNO
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 1:97 SHERMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:802-748-5131
Mailing Address - Fax:
Practice Address - Street 1:97 SHERMAN DR
Practice Address - Street 2:ST JOHNSBURY PEDIATRICS
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819
Practice Address - Country:US
Practice Address - Phone:802-748-5131
Practice Address - Fax:802-748-4237
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007263208000000X
NH10506208000000X
RIMD12441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD12441OtherLICENSE
NH30005904Medicaid
VT0VN0386Medicaid
NH30005904Medicaid
RIMD12441OtherLICENSE