Basic Information
| Provider Information | |||||||||
| NPI: | 1649263617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESTER | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 SOUTH DICKINSON DRIVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284516434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103413300 | ||||||||
| FaxNumber: | 9108152882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 SOUTH DICKINSON DRIVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284516434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103413300 | ||||||||
| FaxNumber: | 9108152882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD19075 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2014-02161 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 061502 | 05 | OR | MEDICAID |