Basic Information
| Provider Information | |||||||||
| NPI: | 1275520702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTI | ||||||||
| FirstName: | MARYANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043163789 | ||||||||
| FaxNumber: | 7043166785 | ||||||||
| Practice Location | |||||||||
| Address1: | 10030 GILEAD RD | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200300915 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 200300915 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | N0091B | 05 | SC | MEDICAID | 891356X | 05 | NC | MEDICAID |