Organization
THETA PATTISON MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THETA PATTISON MD (OWNER)
(518) 690-0177
Entity
Organization
Contact information
Practice address
2508 WESTERN AVE, ALTAMONT, NY 12009-9485
(518) 690-0177
Mailing address
PO BOX 9312, THETA PATTISON MD, SCHENECTADY, NY 12309-0312
(518) 690-0177
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02042400
GROUP MEDICAID
NY
Enumeration date
08/17/2005
Last updated
01/18/2008
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