Provider Demographics
NPI:1972038156
Name:PATRICK, SUMATI (CRNP)
Entity type:Individual
Prefix:
First Name:SUMATI
Middle Name:
Last Name:PATRICK
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 DUNBAR TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-4419
Mailing Address - Country:US
Mailing Address - Phone:301-323-5418
Mailing Address - Fax:
Practice Address - Street 1:8751 GREENBELT RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2450
Practice Address - Country:US
Practice Address - Phone:301-263-3845
Practice Address - Fax:301-263-3569
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188892363LP0808X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01858Medicare PIN