Provider Demographics
NPI:1578639753
Name:NEEDHAM, PATSY D (MD)
Entity Type:Individual
Prefix:DR
First Name:PATSY
Middle Name:D
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 W GREEN MEADOWS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3204
Mailing Address - Country:US
Mailing Address - Phone:317-467-4600
Mailing Address - Fax:317-467-4834
Practice Address - Street 1:400 W GREEN MEADOWS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3204
Practice Address - Country:US
Practice Address - Phone:317-467-4600
Practice Address - Fax:317-467-4834
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01033226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100127890AMedicaid
IN100127890AMedicaid
IND94422Medicare UPIN