MEDICARE: ENDOCRINE AND DIABETES ASSOCIATES, LLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D0031800	MD

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

General Provider Information

NPI Number	:	1730184599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINE AND DIABETES ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	8722 HICKORY BEND TRAIL
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-2557
Country	:	US
Telephone Number	:	301-983-3734
Fax Number	:	301-983-0653

Provider Business Practice Location Address
First Line	:	8722 HICKORY BEND TRAIL
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-2557
Country	:	US
Telephone Number	:	301-983-3734
Fax Number	:	301-983-0653

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. PATRICIA ANNE PETRICK
Credential	:	MD
Telephone Number	:	301-983-3734

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/08/2025

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