Provider Demographics
NPI:1255324232
Name:FLANNAGAN, PATRICK P (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:P
Last Name:FLANNAGAN
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 REFUGEE RD STE 280
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-0019
Practice Address - Country:US
Practice Address - Phone:614-788-8450
Practice Address - Fax:614-788-8470
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053429L207T00000X
OH35.078902207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018117190009Medicaid
PA0018117190009Medicaid
PAH21555Medicare UPIN
OH2233434Medicaid
WV2003059000Medicaid
PA0018117190003Medicaid
PAP00388255Medicare PIN
PA039754N79Medicare PIN