Healthcare Provider Details

I. General information

NPI: 1922307305
Provider Name (Legal Business Name): KATHLEEN MARY PATCHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3149
  • Fax:
Mailing address:
  • Phone: 301-980-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberD78865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: