1508997057 NPI number — DR. GRETCHEN ELIZABETH PATTISON D.O.

Table of content: DR. GRETCHEN ELIZABETH PATTISON D.O. (NPI 1508997057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508997057 NPI number — DR. GRETCHEN ELIZABETH PATTISON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTISON
Provider First Name:
GRETCHEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THIEMECKE
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508997057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WALTER REED NATIONAL MILITARY CTR
Provider Second Line Business Mailing Address:
CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20889-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-295-0576
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALTER REED NATIONAL MILITARY CTR
Provider Second Line Business Practice Location Address:
CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-295-0576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  20A 9830 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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