Provider Demographics
NPI:1235124744
Name:AIELLO, PATRICK D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:AIELLO
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 1:275 W. 28TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7308
Mailing Address - Country:US
Mailing Address - Phone:928-782-1980
Mailing Address - Fax:928-345-2950
Practice Address - Street 1:275 W. 28TH ST.
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7308
Practice Address - Country:US
Practice Address - Phone:928-782-1980
Practice Address - Fax:928-345-2950
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB44060Medicaid
AZB44060Medicaid
C82568Medicare UPIN