Healthcare Provider Details

I. General information

NPI: 1124008438
Provider Name (Legal Business Name): NICHOLAS J PATRONAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WESTERN MARYLAND PKWY SUITE 101
HAGERSTOWN MD
21740-5146
US

IV. Provider business mailing address

10729 ARDNAVE PL
POTOMAC MD
20854-1261
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-1477
  • Fax: 301-733-7758
Mailing address:
  • Phone: 703-287-4189
  • Fax: 703-448-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0027833
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0027833
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: