Provider Demographics
NPI:1215927314
Name:FURNESS, PATRICK T (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:FURNESS
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 1:2109 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3547
Mailing Address - Country:US
Mailing Address - Phone:419-289-1331
Mailing Address - Fax:419-289-9496
Practice Address - Street 1:2109 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3547
Practice Address - Country:US
Practice Address - Phone:419-289-1331
Practice Address - Fax:419-289-9496
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2310029Medicaid
OH4074523Medicare PIN
OH2310029Medicaid
OHH387850Medicare PIN
OHP00085809Medicare PIN