Healthcare Provider Details

I. General information

NPI: 1023783396
Provider Name (Legal Business Name): ADILISHA PATROM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 FLORIDA AVE NE
WASHINGTON DC
20002-3706
US

IV. Provider business mailing address

8715 LAKE EDGE DR
LAUREL MD
20723-4908
US

V. Phone/Fax

Practice location:
  • Phone: 800-390-6515
  • Fax:
Mailing address:
  • Phone: 202-999-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: