Provider Demographics
NPI:1184703506
Name:PATRICK, JAMES TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:PATRICK
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 1:3402 MANDY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3161
Mailing Address - Country:US
Mailing Address - Phone:252-726-7705
Mailing Address - Fax:252-726-7703
Practice Address - Street 1:3402 MANDY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3161
Practice Address - Country:US
Practice Address - Phone:252-726-7705
Practice Address - Fax:252-726-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8866160Medicaid
NC2219709AMedicare PIN
F 34520Medicare UPIN