is a Physician Assistant in Frederick, Maryland. practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for is 1124285184. The last update date is .
's current location address is 1100 W Patrick St Ste H, Frederick, Maryland. You can contact this provider via phone number 3016626478 and fax number 3016626427. The mailing address for is 1100 W Patrick St Ste H, Frederick, Maryland. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1100 W Patrick St Ste H, Frederick, Maryland |
| Phone Number | 3016626478 |
| Fax Number | 3016626427 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1124285184 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1100 W Patrick St Ste H |
|---|---|
| City | Frederick |
| State | Maryland (MD) |
| Post Code | 217033974 |
| Phone Number | 3016626478 |
| Fax Number | 3016626427 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | 1342 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| C04452 | MD | LICENSE | |
| 1342 | WV | LICENSE |
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