Provider Demographics
NPI:1609098086
Name:GEORGE A. PATTERSON, M.D.,P.A.
Entity Type:Organization
Organization Name:GEORGE A. PATTERSON, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-846-1763
Mailing Address - Street 1:888 EASTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1898
Mailing Address - Country:US
Mailing Address - Phone:732-864-1763
Mailing Address - Fax:732-864-1767
Practice Address - Street 1:888 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1898
Practice Address - Country:US
Practice Address - Phone:732-864-1763
Practice Address - Fax:732-864-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03362700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3582205Medicaid
NJ148897Medicare ID - Type UnspecifiedMDCR#
NJ3582205Medicaid