Provider Demographics
NPI:1659471910
Name:KERRIGAN, PATRICK J (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:KERRIGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 HAZLE STREET
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-825-5530
Mailing Address - Fax:570-822-9236
Practice Address - Street 1:476 HAZLE STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-825-5530
Practice Address - Fax:570-822-9236
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005560L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010231440001Medicaid
PA0010231440001Medicaid
460245Medicare ID - Type Unspecified