Provider Demographics
NPI:1750350138
Name:PATTON, EDWARD J (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:PATTON
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 1:190 NONOTUCK ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1911
Mailing Address - Country:US
Mailing Address - Phone:413-586-9866
Mailing Address - Fax:413-585-0070
Practice Address - Street 1:190 NONOTUCK ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1911
Practice Address - Country:US
Practice Address - Phone:413-586-9866
Practice Address - Fax:413-585-0070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA157471OtherCONNECTICARE
MAJ19014OtherBCBSMA
MA24243OtherHNE
MA000000020306OtherBMC
MA3182576Medicaid
MA157471OtherTUFTS
MDG83566OtherHARVARD PILGRIM
MA8175157003OtherCIGNA
MA2631147OtherAETNA
A29005Medicare ID - Type Unspecified
MA000000020306OtherBMC