Healthcare Provider Details

I. General information

NPI: 1851654875
Provider Name (Legal Business Name): PATRICIA CORTAZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12130 GLEN MILL RD
POTOMAC MD
20854-1923
US

IV. Provider business mailing address

10903 NEW HAMPSHIRE AVE ROOM 2333
SILVER SPRING MD
20903-1058
US

V. Phone/Fax

Practice location:
  • Phone: 301-309-1941
  • Fax:
Mailing address:
  • Phone: 301-796-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD52860
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: