Healthcare Provider Details

I. General information

NPI: 1063873933
Provider Name (Legal Business Name): PAUL PATTERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL E PATTERSON MD

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE DEPARTMENT OF PEDIATRICS, WRNMMC
BETHESDA MD
20889
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4941
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101263372
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD485529
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0101263372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: