Healthcare Provider Details

I. General information

NPI: 1306434766
Provider Name (Legal Business Name): PATRICK BOOTH DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

3816 ARCHER PL
KENSINGTON MD
20895-1601
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-2000
  • Fax:
Mailing address:
  • Phone: 302-528-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR231254
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024192693
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR231254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: