MEDICARE: PATTERNS INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	0101234575	VA

General Provider Information

NPI Number	:	1811188477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATTERNS INC

Provider Business Mailing Address
First Line	:	411 1/2 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2311
Country	:	US
Telephone Number	:	703-625-8444
Fax Number	:	703-683-0431

Provider Business Practice Location Address
First Line	:	411 1/2 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2311
Country	:	US
Telephone Number	:	703-625-8444
Fax Number	:	703-683-0431

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FAROOQ MOHYUDDIN
Credential	:	M. D.
Telephone Number	:	703-625-8444

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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