Healthcare Provider Details

I. General information

NPI: 1801870860
Provider Name (Legal Business Name): PATRICIA MARIE PURCELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 WESTPORT RD
LOUISVILLE KY
40207
US

IV. Provider business mailing address

4171 WESTPORT RD
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-8868
  • Fax: 502-895-8794
Mailing address:
  • Phone: 502-896-8868
  • Fax: 502-895-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31333
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: