Provider Demographics
NPI:1780789651
Name:PATTERSON, BENTLEY LORENE (MD)
Entity type:Individual
Prefix:
First Name:BENTLEY
Middle Name:LORENE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5856
Mailing Address - Country:US
Mailing Address - Phone:718-491-8918
Mailing Address - Fax:718-491-8915
Practice Address - Street 1:6811 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5856
Practice Address - Country:US
Practice Address - Phone:718-491-8918
Practice Address - Fax:718-491-8915
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157066-1174400000X
NY157066207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA61918Medicare UPIN