Provider Demographics
NPI:1285749366
Name:PATTERSON, RICHARD EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3024
Mailing Address - Country:US
Mailing Address - Phone:330-665-4100
Mailing Address - Fax:
Practice Address - Street 1:762 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3024
Practice Address - Country:US
Practice Address - Phone:330-665-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103901363AM0700X
SC937363AM0700X, 363AS0400X
OH50.002025363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00218153OtherRAILROAD MEDICARE
SC0206PAMedicaid
SC0206PAMedicaid
NC2760395BMedicare PIN
Q10009Medicare UPIN