Provider Demographics
NPI:1003805433
Name:RADIGAN, PATRICIA E (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:RADIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3779
Mailing Address - Country:US
Mailing Address - Phone:440-244-3833
Mailing Address - Fax:440-244-5328
Practice Address - Street 1:205 W 20TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3779
Practice Address - Country:US
Practice Address - Phone:440-244-3833
Practice Address - Fax:440-244-5328
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711662Medicaid
OH110212652OtherRR MEDICARE
OHA16108Medicare UPIN
OH0711662Medicaid