Provider Demographics
NPI:1932468394
Name:PATMON, BENNIE LAVET JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:LAVET
Last Name:PATMON
Suffix:JR
Gender:M
Credentials:DPM
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Mailing Address - Street 1:13950 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:301-317-6800
Mailing Address - Fax:301-317-5069
Practice Address - Street 1:13950 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-317-6800
Practice Address - Fax:301-317-5069
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD00000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist