Provider Demographics
NPI:1831168798
Name:FANNING, DANA M (PA-C, PT)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:M
Last Name:FANNING
Suffix:
Gender:F
Credentials:PA-C, PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:HOTCHKISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 POND PARK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4347
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-335-6047
Practice Address - Street 1:2 POND PARK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4347
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-335-6047
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15029225100000X
MAAP2410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99510OtherFALLON
MA99510OtherFALLON