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NPI Code Detail

MEDICARE: KENNETH P PATRICK MD

MEDICARE: KENNETH P PATRICK 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
1174400000XSpecialistMD 038376LPA
2207Q00000XFamily Medicine PhysicianMD038376LPA

Other Identifiers

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

General Provider Information

NPI Number : 1548249394
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH P PATRICK MD
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-728-2844
Fax Number : 215-214-1425
Provider Business Practice Location Address
First Line : 333 COTTMAN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-2434
Country : US
Telephone Number : 215-728-6900
Fax Number : 215-214-1425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 03/23/2017

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Directions to “ KENNETH P PATRICK MD” Practice Location

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