Healthcare Provider Details

I. General information

NPI: 1285749366
Provider Name (Legal Business Name): RICHARD EDWARD PATTERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 S CLEVELAND MASSILLON RD
FAIRLAWN OH
44333-3024
US

IV. Provider business mailing address

762 S CLEVELAND MASSILLON RD
FAIRLAWN OH
44333-3024
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-4100
  • Fax:
Mailing address:
  • Phone: 330-665-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103901
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number937
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002025
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number937
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.002025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: