Provider Demographics
NPI:1679519672
Name:FELTON, PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:FELTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9161 LIBERIA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-1727
Mailing Address - Country:US
Mailing Address - Phone:540-274-3205
Mailing Address - Fax:833-464-2578
Practice Address - Street 1:9161 LIBERIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1727
Practice Address - Country:US
Practice Address - Phone:540-274-3205
Practice Address - Fax:833-464-2578
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01460213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76952Medicare UPIN