Healthcare Provider Details

I. General information

NPI: 1144290388
Provider Name (Legal Business Name): PATRICK L NEUSTATTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SAM PERRY BLVD
FREDERICKSBURG VA
22401
US

IV. Provider business mailing address

1301 SAM PERRY BLVD
FREDERICKSBURG VA
22401-8420
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1061
  • Fax: 540-741-1096
Mailing address:
  • Phone: 540-741-1061
  • Fax: 540-741-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101039127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: