Healthcare Provider Details

I. General information

NPI: 1407859846
Provider Name (Legal Business Name): PATRICIA PETRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8722 HICKORY BEND TRAIL
POTOMAC MD
20854-2557
US

IV. Provider business mailing address

8722 HICKORY BEND TRAIL
POTOMAC MD
20854-2557
US

V. Phone/Fax

Practice location:
  • Phone: 301-983-3734
  • Fax: 301-983-0653
Mailing address:
  • Phone: 301-983-3734
  • Fax: 301-983-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0031800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: