Provider Demographics
NPI:1851365035
Name:DYKSTRA, PATRICIA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:597 MERRIMACK ST
Mailing Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-937-9700
Mailing Address - Fax:978-446-9830
Practice Address - Street 1:597 MERRIMACK ST
Practice Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-937-9700
Practice Address - Fax:978-446-9830
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77409208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
042881348OtherBEECH STREET
1339OtherNEIGHBORHOOD HEALTH PLAN
6469876OtherCIGNA
204699OtherHARVARD PILGRIM HLTH CARE
9204204OtherUNITED HEALTH CARE
731688OtherTUFTS
J14028OtherBLUE CROSS BLUE SHIELD
22397OtherFALLON
979892OtherNETWORK HEALTH
3437455OtherAETNA
042881348OtherONE HEALTH
MA1305557Medicaid
042881348OtherCHOICECARE
042881348OtherCHOICECARE
6469876OtherCIGNA