Provider Demographics
NPI:1730123076
Name:ODER, PATRICK D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:ODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:37 CORDIS ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1746
Mailing Address - Country:US
Mailing Address - Phone:781-979-3120
Mailing Address - Fax:781-979-3994
Practice Address - Street 1:585 LEBANON ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3225
Practice Address - Country:US
Practice Address - Phone:781-979-3120
Practice Address - Fax:781-979-3994
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2044282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0134571Medicaid
MAA32858Medicare ID - Type Unspecified
H45910Medicare UPIN