Provider Demographics
NPI:1255568374
Name:PATTI, ANTHONY S (IDMT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:S
Last Name:PATTI
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 NW 68TH TER
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5583
Mailing Address - Country:US
Mailing Address - Phone:954-971-1424
Mailing Address - Fax:
Practice Address - Street 1:PSC 41 BOX 2616
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-0027
Practice Address - Country:US
Practice Address - Phone:0163-871-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians