Provider Demographics
NPI:1699424309
Name:PATERRA, ANTHONY NICHOLAS (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:NICHOLAS
Last Name:PATERRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1211
Mailing Address - Country:US
Mailing Address - Phone:248-660-7479
Mailing Address - Fax:
Practice Address - Street 1:7201 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2913
Practice Address - Country:US
Practice Address - Phone:954-724-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program