Provider Demographics
NPI:1548359318
Name:MCILRATH, PATRICIA ANN (DPM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MCILRATH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 N 5TH STREET HWY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2419
Mailing Address - Country:US
Mailing Address - Phone:610-500-4081
Mailing Address - Fax:610-929-6942
Practice Address - Street 1:2808 N 5TH STREET HWY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2419
Practice Address - Country:US
Practice Address - Phone:610-921-8800
Practice Address - Fax:610-929-6942
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000148213E00000X
PASC004724L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE490830OtherPTAN
DE510407525OtherCIGNA
DE510407525OtherBCBS
DE510407525OtherDEVON
DE0001112317Medicaid
DE182605OtherCOVENTRY
DE510407525OtherUNITED
DE182605OtherCOVENTRY
DE4460550001Medicare NSC