Healthcare Provider Details

I. General information

NPI: 1649419102
Provider Name (Legal Business Name): P. MICHAEL PATTERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LA GRANGE AVE SUITE 101
LA PLATA MD
20646-9592
US

IV. Provider business mailing address

115-A LA GRANGE AVE SUITE 101
LA PLATA MD
20646-9592
US

V. Phone/Fax

Practice location:
  • Phone: 301-392-1935
  • Fax: 301-392-1936
Mailing address:
  • Phone: 301-392-1935
  • Fax: 301-392-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR148876
License Number StateMD

VIII. Authorized Official

Name: DR. PAUL MICHAEL PATTERSON
Title or Position: PRESIDENT
Credential: DNP/FNP
Phone: 301-392-1935