Organization
THETA DERMATOLOGY PC
Active
Organization
THETA DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THETA S PATTISON MD (DIRECTOR)
(518) 690-0177
Entity
Organization
Contact information
Practice address
2508 WESTERN AVE, ALTAMONT, NY 12009-9485
(518) 690-0177
(518) 690-0169
Mailing address
2508 WESTERN AVE, ALTAMONT, NY 12009-9485
(518) 690-0177
(518) 690-0169
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188200
LICENSE
NY
Enumeration date
12/06/2017
Last updated
12/06/2017
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