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NPI Code Detail

MEDICARE: PATRICK OLISE PA

MEDICARE: PATRICK OLISE PA
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
1363A00000XPhysician AssistantPA2016-0024NM
2363A00000XPhysician Assistant7242GA

General Provider Information

NPI Number : 1770990848
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK OLISE PA
Provider Business Mailing Address
First Line : PO BOX 844088
Second Line :
City : DALLAS
State : TX
Zip : 75284-4088
Country : US
Telephone Number : 505-609-2258
Fax Number : 505-609-2259
Provider Business Practice Location Address
First Line : 55 WHITCHER ST NE STE 160
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1160
Country : US
Telephone Number : 770-422-1372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 11/12/2024

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