Provider Demographics
NPI:1124028410
Name:PATRONELLA, ALLYSON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:THOMAS
Last Name:PATRONELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:LYNETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4581
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4581
Mailing Address - Country:US
Mailing Address - Phone:713-464-2100
Mailing Address - Fax:281-392-7911
Practice Address - Street 1:18300 KATY FWY
Practice Address - Street 2:SUITE 315
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1385
Practice Address - Country:US
Practice Address - Phone:713-464-2100
Practice Address - Fax:281-392-7911
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0962250-01Medicaid
TX8U9983OtherBC/BS NUMBER
G52134Medicare UPIN
TX8F2843Medicare PIN