Provider Demographics
NPI:1649419102
Name:P. MICHAEL PATTERSON
Entity Type:Organization
Organization Name:P. MICHAEL PATTERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-392-1935
Mailing Address - Street 1:115 LA GRANGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9592
Mailing Address - Country:US
Mailing Address - Phone:301-392-1935
Mailing Address - Fax:301-392-1936
Practice Address - Street 1:115 LA GRANGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9592
Practice Address - Country:US
Practice Address - Phone:301-392-1935
Practice Address - Fax:301-392-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ35304Medicare UPIN
MD491937Medicare PIN