Provider Demographics
NPI:1407859846
Name:PETRICK, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PETRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 ROCKLEDGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1847
Mailing Address - Country:US
Mailing Address - Phone:301-468-1451
Mailing Address - Fax:301-468-3580
Practice Address - Street 1:6430 ROCKLEDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1847
Practice Address - Country:US
Practice Address - Phone:301-468-1451
Practice Address - Fax:301-468-3580
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377861400Medicaid
MD103471Medicare ID - Type Unspecified
MD377861400Medicaid