Provider Demographics
NPI:1487066791
Name:PATTERSON GENTILE, CARLYN (MD, PHD)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:PATTERSON GENTILE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:500 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2219
Practice Address - Country:US
Practice Address - Phone:215-997-9610
Practice Address - Fax:215-997-5731
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4664732084N0402X
PAMT207073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics