Provider Demographics
NPI:1124007448
Name:PATTON, LARRY (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 VALLEY VIEW BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2040
Mailing Address - Country:US
Mailing Address - Phone:540-265-1604
Mailing Address - Fax:540-265-1684
Practice Address - Street 1:4910 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2040
Practice Address - Country:US
Practice Address - Phone:540-265-1604
Practice Address - Fax:540-265-1684
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040969207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00277055OtherMEDICARE RAILROAD
VAB07680Medicare UPIN
VAP00277055OtherMEDICARE RAILROAD