Provider Demographics
NPI:1285822288
Name:PATRICK, EDWARD LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEE
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BARRY'S ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661
Mailing Address - Country:US
Mailing Address - Phone:570-443-7959
Mailing Address - Fax:570-443-7958
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-421-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053183363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical