Healthcare Provider Details

I. General information

NPI: 1811940919
Provider Name (Legal Business Name): PATRICK TRIPLETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64260
BALTIMORE MD
21264-4260
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD60889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: