Provider Demographics
NPI:1881668523
Name:PATTERSON, JAN LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:LOUISE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1849
Mailing Address - Country:US
Mailing Address - Phone:518-779-5225
Mailing Address - Fax:
Practice Address - Street 1:242 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3522
Practice Address - Country:US
Practice Address - Phone:518-779-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251806207Q00000X
TXJ5862207Q00000X
NC38549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE58013Medicare UPIN