Individual provider Active NPI

Pamela Rae Lawrence Fanning, PA-C

  • Physician Assistant
  • Norwalk, CT
National Provider Identifier
1043438435
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
000711 Issued in CT
Practice address
24 Stevens St
Norwalk, CT 06850-3852
Phone
(203) 852-2671
Fax
(203) 852-2057
NPI assigned
Apr 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000711 CT Primary

Addresses

Primary practice location

24 Stevens St
Norwalk, CT 06850-3852

Mailing address

24 Stevens St
Norwalk, CT 06850-3852
Phone (203) 852-2671

Other names 1

  • Pamela Fanning Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160404000373 CT Practitioner - Physician Assistant 6507163771 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000711CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Children'S Specialty Group, Inc. Physician Assistant CurrentSince Mar 6, 2018 Accepting new patients
Village Pediatrics Past Accepting new patients

Locations

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

10 Columbus Blvd
Fl 4
Hartford, CT 06106
Phone (860) 837-5560

10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619

282 Washington St
Hartford, CT 06106
Phone (860) 545-8950

Interoperability endpoints

  • Direct secure messaging: pfanning36249@connecticutchildrens.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1043438435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 STEVENS ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503852",
            "telephone_number": "203-852-2671",
            "fax_number": "203-852-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 STEVENS ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503852",
            "telephone_number": "203-852-2671",
            "fax_number": "203-852-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE FANNING",
        "first_name": "PAMELA",
        "middle_name": "RAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "000711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "FANNING",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.