Healthcare Provider Details

I. General information

NPI: 1730184599
Provider Name (Legal Business Name): ENDOCRINE AND DIABETES ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/08/2025
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: DR. PATRICIA ANNE PETRICK
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 301-983-3734