MEDICARE: JOHN D. PATRICK M.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	174400000X	Specialist	33415	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220023044	OTHER	NC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1861487902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D. PATRICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 13508
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27415-3508
Country	:	US
Telephone Number	:	336-271-4930
Fax Number	:	336-271-8466

Provider Business Practice Location Address
First Line	:	501 N ELAM AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1118
Country	:	US
Telephone Number	:	336-271-4930
Fax Number	:	336-271-8466

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/11/2008

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