Provider Demographics
NPI:1235370461
Name:DENNISON, PATRICK ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ROBERT
Last Name:DENNISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1583
Mailing Address - Country:US
Mailing Address - Phone:740-296-5702
Mailing Address - Fax:740-296-5705
Practice Address - Street 1:135 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1583
Practice Address - Country:US
Practice Address - Phone:740-296-5702
Practice Address - Fax:740-296-5705
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0037799207Q00000X
NY276924-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04044859Medicaid
OH0742076Medicaid
OH4259521Medicare PIN
NY04044859Medicaid