MEDICARE: PATRICK AHERN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	V1722	TX
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	186037	CA

General Provider Information

NPI Number	:	1154883072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK AHERN MD

Provider Business Mailing Address
First Line	:	2612 SAN JOAQUIN HILLS RD
Second Line	:
City	:	CORONA DEL MAR
State	:	CA
Zip	:	92625-1127
Country	:	US
Telephone Number	:	619-708-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PLAZA DRIVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92697-7708
Country	:	US
Telephone Number	:	949-824-7246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	06/20/2024

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