Provider Demographics
NPI:1972718880
Name:PATTON, LARRY ALAN
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALAN
Last Name:PATTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70100 BANNOCK UNIONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9600
Mailing Address - Country:US
Mailing Address - Phone:740-968-2996
Mailing Address - Fax:740-968-2996
Practice Address - Street 1:70100 BANNOCK UNIONTOWN RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9600
Practice Address - Country:US
Practice Address - Phone:740-968-2996
Practice Address - Fax:740-968-2996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2424335374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424335Medicaid