Provider Demographics
NPI:1841252202
Name:PATTERSON, CHARLES W (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:PATTERSON
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 1:24261 ROWEL CT
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-7003
Mailing Address - Country:US
Mailing Address - Phone:661-821-1910
Mailing Address - Fax:661-821-1910
Practice Address - Street 1:24261 ROWEL CT
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-7003
Practice Address - Country:US
Practice Address - Phone:661-821-1910
Practice Address - Fax:661-821-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ118002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYD39088Medicare UPIN
KY1883401Medicare ID - Type Unspecified