Healthcare Provider Details

I. General information

NPI: 1053391953
Provider Name (Legal Business Name): JONATHAN L PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FEDERAL ST STE 4
MILTON DE
19968-1157
US

IV. Provider business mailing address

611 FEDERAL ST STE 4
MILTON DE
19968-1157
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-5151
  • Fax: 302-684-1977
Mailing address:
  • Phone: 302-684-5151
  • Fax: 302-684-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0065095
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberC10004811
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberC10004811
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberC10004811
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC10004811
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC10004811
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: