Provider Demographics
NPI:1346214079
Name:PATTERSON, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:PATTERSON
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 932
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0932
Mailing Address - Country:US
Mailing Address - Phone:919-776-3750
Mailing Address - Fax:919-776-3750
Practice Address - Street 1:1411 GREENWAY COURT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-776-3750
Practice Address - Fax:919-776-3760
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-66199Medicaid
NC66199OtherBCBS
NCC81178Medicare UPIN
NC202278HMedicare PIN