Provider Demographics
NPI:1568425486
Name:MCENTIRE, PATRICIA MOURILHE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MOURILHE
Last Name:MCENTIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MOURILHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1613 DUNTERRY PL
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4318
Mailing Address - Country:US
Mailing Address - Phone:212-566-7048
Mailing Address - Fax:866-648-7658
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:KENNER ARMY CLINIC
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218670-12084F0202X
MDD00667612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905428Medicaid
NCH01092Medicare UPIN
NC2059851Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER