Provider Demographics
NPI:1730184599
Name:ENDOCRINE AND DIABETES ASSOCIATES, LLC
Entity type:Organization
Organization Name:ENDOCRINE AND DIABETES ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-983-3734
Mailing Address - Street 1:8722 HICKORY BEND TRAIL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2557
Mailing Address - Country:US
Mailing Address - Phone:301-983-3734
Mailing Address - Fax:301-983-0653
Practice Address - Street 1:8722 HICKORY BEND TRAIL
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2557
Practice Address - Country:US
Practice Address - Phone:301-983-3734
Practice Address - Fax:301-983-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5499011Medicaid
MD=========OtherTAX ID NUMBER
MD5499011Medicaid