Provider Demographics
NPI:1508054156
Name:PATRICIO MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PATRICIO MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATRICIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-437-5270
Mailing Address - Street 1:25 HIGHLAND PARK DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8402
Mailing Address - Country:US
Mailing Address - Phone:724-437-0100
Mailing Address - Fax:
Practice Address - Street 1:25 HIGHLAND PARK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8402
Practice Address - Country:US
Practice Address - Phone:724-437-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034247L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55478Medicare UPIN