Provider Demographics
NPI:1669518957
Name:PATRICOSKI, CHRISTOPHER THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:PATRICOSKI
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 1:14235 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3961
Mailing Address - Country:US
Mailing Address - Phone:907-522-5570
Mailing Address - Fax:
Practice Address - Street 1:12350 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4300
Practice Address - Country:US
Practice Address - Phone:907-345-4343
Practice Address - Fax:907-345-6232
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF17799Medicare UPIN