Basic Information
| Provider Information | |||||||||
| NPI: | 1710036231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOETZ | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LOHR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 PITKIN DR | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442362263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304529812 | ||||||||
| FaxNumber: | 3304301288 | ||||||||
| Practice Location | |||||||||
| Address1: | 832 MCKINLEY AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447032463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304529812 | ||||||||
| FaxNumber: | 3304301288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 08/18/2012 | ||||||||
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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 | 2084P0800X | 35-056415 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 35-056415 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | AG8069684 | 01 | OH | DEA | OTHER | 0061609 | 05 | OH | MEDICAID |