Provider Demographics
NPI:1144290388
Name:NEUSTATTER, PATRICK L (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:NEUSTATTER
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 1:1301 SAM PERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8420
Mailing Address - Country:US
Mailing Address - Phone:540-741-1061
Mailing Address - Fax:540-741-1096
Practice Address - Street 1:1301 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-741-1061
Practice Address - Fax:540-741-1096
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0898100OtherAETNA HMO
VA005636973Medicaid
VA285302OtherANTHEM
VA4092057OtherAETNA NON HMO
VA82929OtherMAMSI
VA0101039127OtherLICENSE
VACA9037OtherMCR RAILROAD GROUP
VA00090768OtherAETNA CAP
VACO2375OtherMEDICARE GROUP