Provider Demographics
NPI:1487010070
Name:PATALIVE, ZANE ADAM (PA-C)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:ADAM
Last Name:PATALIVE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 FRANKLIN SQUARE DR
Mailing Address - Street 2:DEPARTMENT OF PHYSICIAN ASSISTANT SERVICES
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3901
Mailing Address - Country:US
Mailing Address - Phone:443-777-7415
Mailing Address - Fax:
Practice Address - Street 1:3333 N CALVERT ST STE 655
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-554-2867
Practice Address - Fax:410-554-2917
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant