Provider Demographics
NPI:1437297934
Name:MCCULLOCH, PATRICK T (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:MCCULLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 TRICH DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5990
Mailing Address - Country:US
Mailing Address - Phone:724-225-8657
Mailing Address - Fax:724-228-8388
Practice Address - Street 1:100 TRICH DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5990
Practice Address - Country:US
Practice Address - Phone:724-225-8657
Practice Address - Fax:724-228-8388
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018797720002Medicaid
PA113233Y09Medicare PIN