Healthcare Provider Details

I. General information

NPI: 1497958151
Provider Name (Legal Business Name): KERRY BLAINE PATTERSON MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD BLDG 808
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

4719 HANRAHAN PL
ALEXANDRIA VA
22309-4528
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-8312
  • Fax:
Mailing address:
  • Phone: 703-780-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberM-5208
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: