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General NPI Number Information
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NPI Number | 1376177923
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Entity Type | Individual
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Provider Name | LIESL MARIE PATETTA MD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2020
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | BOX 3135 DUMC
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City | DURHAM
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State | NC
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Zip | 27710-1443
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Country | US
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Telephone | 919-385-3376
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Fax |
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Provider Business Mailing Address
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Address Line | BOX 3135 DUMC
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City | DURHAM
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State | NC
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Zip | 27710-0001
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Country | US
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Telephone | 919-385-3376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2025-01410
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 125078920
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License Number State | IL
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