Provider Demographics
NPI:1700997210
Name:FONE, PATRICIA D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:FONE
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3 MEDICAL PLAZA DR
Practice Address - Street 2:#250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3087
Practice Address - Country:US
Practice Address - Phone:916-797-4720
Practice Address - Fax:916-797-4721
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74706208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G747060Medicaid
00G747060Medicare ID - Type Unspecified
G14276Medicare UPIN