Provider Demographics
NPI:1235134701
Name:KELLOGG, PATRICIA DEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DEAL
Last Name:KELLOGG
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:PO BOX 79632
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0632
Mailing Address - Country:US
Mailing Address - Phone:301-762-5020
Mailing Address - Fax:301-309-3783
Practice Address - Street 1:1201 SEVEN LOCKS RD
Practice Address - Street 2:STE 111
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2957
Practice Address - Country:US
Practice Address - Phone:301-762-5020
Practice Address - Fax:301-294-7569
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415096100Medicaid
DC112264Medicare PIN
DC190081Medicare PIN
MDB93447Medicare UPIN