Provider Demographics
NPI:1609830447
Name:PATTERSON, ALONZO III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALONZO
Middle Name:
Last Name:PATTERSON
Suffix:III
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:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:1152 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6847
Practice Address - Country:US
Practice Address - Phone:937-268-3483
Practice Address - Fax:937-268-1884
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060175P208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000194421OtherANTHEM PROVIDER NUMBER
OH0791997Medicaid
OH0791997Medicaid
110180077Medicare PIN
OH000000194421OtherANTHEM PROVIDER NUMBER