Provider Demographics
NPI:1306823448
Name:O'GRADY, PATRICK M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:O'GRADY
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 1:411 - 10TH ST SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2449
Mailing Address - Country:US
Mailing Address - Phone:319-363-3600
Mailing Address - Fax:319-363-9971
Practice Address - Street 1:411 - 10TH ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2449
Practice Address - Country:US
Practice Address - Phone:319-363-3600
Practice Address - Fax:319-363-9971
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22112208000000X
IA27407208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47079049100Medicaid