Provider Demographics
NPI: | 1558462093 |
---|---|
Name: | PATCHELL, ROY ANDREW (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROY |
Middle Name: | ANDREW |
Last Name: | PATCHELL |
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: | 2 CAPITAL WAY |
Mailing Address - Street 2: | SUITE 456 |
Mailing Address - City: | PENNINGTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08534-2521 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-537-7300 |
Mailing Address - Fax: | 609-537-7301 |
Practice Address - Street 1: | 2 CAPITAL WAY |
Practice Address - Street 2: | SUITE 456 |
Practice Address - City: | PENNINGTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08534-2521 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-537-7300 |
Practice Address - Fax: | 609-537-7301 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2016-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 41699 | 2084P0804X, 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 437271 | Medicaid | |
AZ | Z129567 | Medicare PIN |