Provider Demographics
NPI:1760687156
Name:WIDRA, PATRICIA FERRIE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:FERRIE
Last Name:WIDRA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:FERRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 S PACA ST # 4TH
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1642
Mailing Address - Country:US
Mailing Address - Phone:410-328-6735
Mailing Address - Fax:833-583-0630
Practice Address - Street 1:701 W PRATT ST FL 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:833-583-0630
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00461062084P0800X
CODR.00656342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029341OtherKAISER COMMERCIAL NUMBER