Provider Demographics
NPI:1801888318
Name:PATROWICZ, JONATHAN C (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:PATROWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3158
Mailing Address - Country:US
Mailing Address - Phone:410-334-3788
Mailing Address - Fax:410-334-3599
Practice Address - Street 1:1820 SWEET BAY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-334-3788
Practice Address - Fax:410-334-3599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH57291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH48014Medicare UPIN
MD816M427FMedicare ID - Type Unspecified