Provider Demographics
NPI:1316124993
Name:GEORGE B. PATRICK, III, MD, PA
Entity type:Organization
Organization Name:GEORGE B. PATRICK, III, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BRANCH
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:301-585-6565
Mailing Address - Street 1:9221 COLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1657
Mailing Address - Country:US
Mailing Address - Phone:301-585-6565
Mailing Address - Fax:301-585-3111
Practice Address - Street 1:9221 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1657
Practice Address - Country:US
Practice Address - Phone:301-585-6565
Practice Address - Fax:301-585-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411953Medicare PIN
B92950Medicare UPIN