Provider Demographics
NPI:1336325117
Name:CVELIC, PATRICK (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:CVELIC
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 IDOL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7804
Mailing Address - Country:US
Mailing Address - Phone:336-802-4000
Mailing Address - Fax:336-802-2401
Practice Address - Street 1:611 N LINDSAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4300
Practice Address - Country:US
Practice Address - Phone:336-802-2250
Practice Address - Fax:336-802-2251
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759108Medicare PIN