Provider Demographics
NPI:1487633236
Name:DENNIS, PATRICK M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:DENNIS
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 1:1503 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2543
Mailing Address - Country:US
Mailing Address - Phone:252-522-1611
Mailing Address - Fax:252-522-0189
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-522-1611
Practice Address - Fax:252-522-0189
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24377207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28336OtherBCBS IND PROV ID
NC8928336Medicaid
NC8901153Medicaid
NC01153OtherBCBS GROUP PROV ID
NC8928336Medicaid
NCC83511Medicare UPIN
NC2321495Medicare ID - Type UnspecifiedMEDICARE GROUP #