Provider Demographics
NPI:1962451682
Name:HA, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HA
Suffix:
Gender:M
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST STE 401
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5834
Practice Address - Country:US
Practice Address - Phone:443-849-8940
Practice Address - Fax:443-849-8965
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63783207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKG72/64784403OtherCAREFIRST MARYLAND GBMC
MD409744100Medicaid
MDS1430005OtherCAREFIRST REGIONAL GBMC
MDP00315650Medicare PIN
MDS1430005OtherCAREFIRST REGIONAL GBMC
MD409744100Medicaid
MDKR60N237Medicare PIN
MD712L/676LN466Medicare PIN