MEDICARE: DR. MARK A PATTERSON 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	208000000X	Pediatrics Physician	0101048168	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A PATTERSON MD

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 POSTAL DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6438
Country	:	US
Telephone Number	:	540-772-4453
Fax Number	:	540-722-4717

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/11/2025

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