Provider Demographics
NPI:1053391953
Name:PATTERSON, JONATHAN L (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FEDERAL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1157
Mailing Address - Country:US
Mailing Address - Phone:302-684-5151
Mailing Address - Fax:302-684-1977
Practice Address - Street 1:611 FEDERAL ST STE 4
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1157
Practice Address - Country:US
Practice Address - Phone:302-684-5151
Practice Address - Fax:302-684-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00650952085R0202X
DEC100048112085U0001X, 2085B0100X, 2085D0003X, 2085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200064773Medicaid
DE563542M67Medicare PIN
DE0000776901Medicaid