Provider Demographics
NPI:1245277094
Name:GRODIN, PATRICIA ANN (RN,MS,CS,P)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:GRODIN
Suffix:
Gender:F
Credentials:RN,MS,CS,P
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:WORTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1435 BAY HEAD RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5708
Mailing Address - Country:US
Mailing Address - Phone:410-349-3456
Mailing Address - Fax:410-268-5597
Practice Address - Street 1:3305 N LEISURE WORLD BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1367
Practice Address - Country:US
Practice Address - Phone:301-598-1554
Practice Address - Fax:301-598-1569
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063595163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00157614OtherMEDICAIRE RR
MD031254L41Medicare ID - Type Unspecified
MDP00157614OtherMEDICAIRE RR