Healthcare Provider Details

I. General information

NPI: 1396134052
Provider Name (Legal Business Name): WESLEY PATTERSON MS ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date: 01/25/2018
Reactivation Date: 04/25/2018

III. Provider practice location address

16700 SWANSON COVE CT
HUGHESVILLE MD
20637-2804
US

IV. Provider business mailing address

16700 SWANSON COVE CT
HUGHESVILLE MD
20637-2804
US

V. Phone/Fax

Practice location:
  • Phone: 240-320-2418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: