Provider Demographics
NPI:1285639617
Name:PATTERSON, PAUL MICHAEL (DNP)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115A LA GRANGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9597
Mailing Address - Country:US
Mailing Address - Phone:301-392-1935
Mailing Address - Fax:301-392-1936
Practice Address - Street 1:115A LA GRANGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9597
Practice Address - Country:US
Practice Address - Phone:301-392-1935
Practice Address - Fax:301-392-1936
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491937Medicare PIN
MDQ35304Medicare UPIN