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General NPI Number Information
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NPI Number | 1750860466
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Entity Type | Individual
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Provider Name | MKRTICH PATATANYAN DO
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Gender | Male
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 96 15TH ST NW STE 106
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City | NORTON
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State | VA
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Zip | 24273-1625
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Country | US
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Telephone | 276-678-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 RIVERBEND DR APT 105
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City | KINGSPORT
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State | TN
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Zip | 37664-4081
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Country | US
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Telephone | 818-903-3266
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20A18882
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0116032277
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License Number State | VA
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