Provider Demographics
NPI:1407859846
Name:PETRICK, PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PETRICK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 HICKORY BEND TRAIL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2557
Mailing Address - Country:US
Mailing Address - Phone:301-983-3734
Mailing Address - Fax:301-983-0653
Practice Address - Street 1:8722 HICKORY BEND TRAIL
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2557
Practice Address - Country:US
Practice Address - Phone:301-983-3734
Practice Address - Fax:301-983-0653
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377861400Medicaid
MD103471Medicare ID - Type Unspecified
MD377861400Medicaid