Individual provider Active NPI

Larry Patton, MD

  • Dermatology Physician
  • Roanoke, VA
National Provider Identifier
1124007448
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
0101040969 Issued in VA
Practice address
4910 Valley View Blvd NW
Roanoke, VA 24012-2040
Phone
(540) 265-1604
Fax
(540) 265-1684
NPI assigned
Jan 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 0101040969 VA Primary

Addresses

Primary practice location

4910 Valley View Blvd NW
Roanoke, VA 24012-2040

Mailing address

4910 Valley View Blvd NW
Roanoke, VA 24012-2040
Phone (540) 265-1604

Other identifiers 1

IdentifierTypeStateIssuer
P00277055OtherVAMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101040969VAMDDermatology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1124007448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122040",
            "telephone_number": "540-265-1604",
            "fax_number": "540-265-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122040",
            "telephone_number": "540-265-1604",
            "fax_number": "540-265-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTON",
        "first_name": "LARRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101040969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00277055",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.