Provider Demographics
NPI:1023220985
Name:AQUILINA, PATRICK MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:AQUILINA
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 1:545 N RIVER ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2643
Mailing Address - Country:US
Mailing Address - Phone:570-819-2825
Mailing Address - Fax:570-819-1445
Practice Address - Street 1:545 N RIVER ST STE 240
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2643
Practice Address - Country:US
Practice Address - Phone:570-819-2825
Practice Address - Fax:570-819-1445
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071993L207RC0000X, 207R00000X, 207RC0001X
GA072263207RC0001X
WAMD60824224207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149062AMedicaid
WI1023220985Medicaid
GA202I212520Medicare PIN