Healthcare Provider Details

I. General information

NPI: 1972123222
Provider Name (Legal Business Name): AUSTIN M PATTERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 WAYNE ST STE 200
MARIETTA OH
45750-3300
US

IV. Provider business mailing address

802 WAYNE ST STE 200
MARIETTA OH
45750-3300
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-6030
  • Fax: 740-374-6029
Mailing address:
  • Phone: 740-374-6030
  • Fax: 740-374-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4299
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.017469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: