Provider Demographics
NPI:1023783396
Name:PATROM, ADILISHA
Entity type:Individual
Prefix:
First Name:ADILISHA
Middle Name:
Last Name:PATROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 LAKE EDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-4908
Mailing Address - Country:US
Mailing Address - Phone:202-999-9722
Mailing Address - Fax:
Practice Address - Street 1:1002 FLORIDA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3706
Practice Address - Country:US
Practice Address - Phone:800-390-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist