Provider Demographics
NPI:1134197072
Name:FRONT ROYAL INTERNAL MEDICINE ASSOC LTD
Entity type:Organization
Organization Name:FRONT ROYAL INTERNAL MEDICINE ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATTESON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:540-636-6131
Mailing Address - Street 1:315 W 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2803
Mailing Address - Country:US
Mailing Address - Phone:540-636-6131
Mailing Address - Fax:540-636-8774
Practice Address - Street 1:315 W 10TH STREET
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2803
Practice Address - Country:US
Practice Address - Phone:540-636-6131
Practice Address - Fax:540-636-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134197072OtherNPI
1134197072OtherNPI