Provider Demographics
NPI:1972532422
Name:PATRAGNONI, RICHARD M (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:PATRAGNONI
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 1:401 ROUTE 73 N
Mailing Address - Street 2:40 LAKE CENTER DRIVE, SUITE 201A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-953-7105
Practice Address - Fax:609-953-0042
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02604700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1816403Medicaid
NJ171845R63Medicare PIN
NJ171845YBAWMedicare PIN
NJ544997DPTMedicare ID - Type Unspecified
E13959Medicare UPIN