MEDICARE: PATRICIA BULLARD-BATES PHD

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	103TC0700X	Clinical Psychologist	1421	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H360-0007	OTHER	DC	BS OF NCA
2	247625	OTHER		MAMSI
3	40710022	OTHER	DC	BCBS
4	123386323	OTHER		TRICARE
5	737285-000	OTHER		AETNA
6	549622-04	OTHER	MD	BS OF MD
7	737285-000	OTHER		AETNA HMO

General Provider Information

NPI Number	:	1770551038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BULLARD-BATES PHD

Provider Business Mailing Address
First Line	:	102 IRVING ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 IRVING ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2921
Country	:	US
Telephone Number	:	202-877-1170
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	06/25/2009

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Directions to “ PATRICIA BULLARD-BATES PHD” Practice Location

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