Michael A Patrician, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS023284 Issued in PA

Practice address

109 Main Ave
Clarks Summit, PA 18411-1522

Phone

(570) 586-8986

NPI assigned

Nov 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1225219355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MAIN AVE",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111523",
            "telephone_number": "570-586-8986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MAIN AVE",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111522",
            "telephone_number": "570-586-8986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICIAN",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS023284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PA Deptment of Public Welfare
• Anthony Joseph Pagnotti, ED.D.
• Samir Bipin Pancholy, M.D.
• Kristin Ann Paoli, DMD
• Eugena Patackas, MS LBS LPC NCC
• Pennsylvania CVS Pharmacy, L.L.C.
• Pennsylvania Department of Human Services
• William Peoples
• Allan F Perfilio, DC
• Lindsey Philbin

• Dentist in Clarks Summit, PA
• Providers in Clarks Summit, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.