Provider Demographics
NPI:1649263617
Name:TESTER, PATRICK W (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:TESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1333 SOUTH DICKINSON DRIVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6434
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-815-2882
Practice Address - Street 1:1333 SOUTH DICKINSON DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6434
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-815-2882
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19075207R00000X
NC2014-02161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061502Medicaid
OR061502Medicaid
ORR104631Medicare PIN
ORR104631Medicare PIN