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1437306651

NPI Code Detail

MEDICARE: DR. PATRICK PROGAR PH.D.

MEDICARE: DR. PATRICK PROGAR PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS-008949-L	PA
2	103TB0200X	Cognitive & Behavioral Psychologist	PS-008949-L	PA
3	103TC0700X	Clinical Psychologist	PS-008949-L	PA
4	103TC2200X	Clinical Child & Adolescent Psychologist	PS-008949-L	PA
5	103TF0000X	Family Psychologist	PS-008949-L	PA
6	103TH0004X	Health Psychologist	PS-008949-L	PA
7	103TH0100X	Health Service Psychologist	PS-008949-L	PA
8	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PS-008949-L	PA
9	103TR0400X	Rehabilitation Psychologist	PS-008949-:	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS-008949-L	OTHER	PA	PENNSYLVANIA LICENSE TO PRACTICE PSYCHOLOGY

General Provider Information

NPI Number	:	1437306651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK PROGAR PH.D.

Provider Business Mailing Address
First Line	:	24 OAK CT
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8333
Country	:	US
Telephone Number	:	973-618-3919
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 W KINGS HWY
Second Line	:
City	:	COATESVILLE
State	:	PA
Zip	:	19320-1714
Country	:	US
Telephone Number	:	610-383-1432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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Directions to “ DR. PATRICK PROGAR PH.D.” Practice Location

Language	Start Address	Practice Location

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