Provider Demographics
NPI:1689614299
Name:AUTH, PATRICK (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:AUTH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:232 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2319
Mailing Address - Country:US
Mailing Address - Phone:215-442-5021
Mailing Address - Fax:215-957-2875
Practice Address - Street 1:16TH ST AND GIRARD AVENUES
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-787-9068
Practice Address - Fax:215-787-9286
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001124L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant