Provider Demographics
NPI:1265601645
Name:PATRICIA A. FODOR, M.D. P.C.
Entity type:Organization
Organization Name:PATRICIA A. FODOR, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPC
Authorized Official - Phone:719-598-9991
Mailing Address - Street 1:7606 N. UNION
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-598-9990
Mailing Address - Fax:719-598-2044
Practice Address - Street 1:7606 N. UNION
Practice Address - Street 2:SUITE G
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-598-9990
Practice Address - Fax:719-598-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO327252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14287820Medicaid
COC519078Medicare PIN