Healthcare Provider Details

I. General information

NPI: 1508293176
Provider Name (Legal Business Name): JOHN C. PATTERSON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS RD SUITE 201-A
CLINTON MD
20735-3362
US

IV. Provider business mailing address

7501 SURRATTS RD SUITE 201-A
CLINTON MD
20735-3362
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-5900
  • Fax:
Mailing address:
  • Phone: 301-856-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD0019633
License Number StateMD

VIII. Authorized Official

Name: DR. JOHN CLAYTON PATTERSON
Title or Position: OWNER
Credential: M.D.
Phone: 301-856-5900