Provider Demographics
NPI:1770585358
Name:PATEY, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PATEY
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 1:116 WINDY PT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9371
Mailing Address - Country:US
Mailing Address - Phone:740-516-6062
Mailing Address - Fax:740-374-5790
Practice Address - Street 1:4697 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1338
Practice Address - Country:US
Practice Address - Phone:740-671-1250
Practice Address - Fax:740-671-1265
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062051207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0044824000Medicaid
OHP01449330OtherRAILROAD MEDICARE
OH0893896Medicaid
WV0044824000Medicaid
OH0893896Medicaid