Provider Demographics
NPI:1649366220
Name:PATRICK, DIANE F (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:F
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-9650
Practice Address - Fax:508-973-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-04-23
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Provider Licenses
StateLicense IDTaxonomies
MA57488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWCC42489Medicaid
MA110044109AMedicaid
MAJ0617704Medicare PIN
MAM15040Medicare ID - Type Unspecified