Healthcare Provider Details

I. General information

NPI: 1760687156
Provider Name (Legal Business Name): PATRICIA FERRIE WIDRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA MARIE FERRIE

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

110 S PACA ST # 4TH
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5881
  • Fax: 833-583-0630
Mailing address:
  • Phone: 410-328-6735
  • Fax: 833-583-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0046106
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: