Provider Demographics
NPI:1205873502
Name:PATRICK, DAVID BRICE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRICE
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 1:1700 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1715
Mailing Address - Country:US
Mailing Address - Phone:724-775-6446
Mailing Address - Fax:724-775-4856
Practice Address - Street 1:1700 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1715
Practice Address - Country:US
Practice Address - Phone:724-775-6446
Practice Address - Fax:724-775-4856
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019128E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34752Medicare UPIN
PA066013Medicare ID - Type UnspecifiedMEDICARE