Provider Demographics
NPI:1003175985
Name:PATTERSON, BRADLEY J (LAC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 BARNES ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3958
Mailing Address - Country:US
Mailing Address - Phone:410-638-5544
Mailing Address - Fax:
Practice Address - Street 1:424 BARNES ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3958
Practice Address - Country:US
Practice Address - Phone:410-638-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist