Provider Demographics
NPI:1740213370
Name:ROBERT W PATTERSON MD PA
Entity Type:Organization
Organization Name:ROBERT W PATTERSON MD PA
Other - Org Name:THE FAMILY DOC DIAGNOSTIC AND WELLNESS CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-776-3750
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:SANFORD
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0932
Mailing Address - Country:US
Mailing Address - Phone:919-776-3750
Mailing Address - Fax:919-776-3760
Practice Address - Street 1:1411 GREENWAY COURT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-776-3750
Practice Address - Fax:919-776-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0115LMedicaid
NC0115LOtherBC/BS GROUP NUMBER
NC2344377Medicare PIN