Provider Demographics
NPI:1881664126
Name:PATTERSON, CAROL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PINELLAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3804
Mailing Address - Country:US
Mailing Address - Phone:727-462-7907
Mailing Address - Fax:727-462-7904
Practice Address - Street 1:300 PINELLAS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3804
Practice Address - Country:US
Practice Address - Phone:727-462-7907
Practice Address - Fax:727-462-7904
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21883207R00000X, 208000000X
KY52811207R00000X, 208M00000X
FLME151814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64102791Medicaid
OH245649Medicaid
WV5805445OtherCIGNA
WV1068790OtherBRICKSTREET COMP
WV3810002977Medicaid
KY6410279100OtherKY HEALTH CHOICES
OH2610142Medicaid
WV613154600OtherBLACK LUNG
WV7250740OtherAETNA
KY6410279100OtherKY HEALTH CHOICES
WV3810002977Medicaid
WVP00642697Medicare PIN