Healthcare Provider Details

I. General information

NPI: 1548840341
Provider Name (Legal Business Name): ALICIA HELMAN PANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALTER WARD BLVD STE 100
ABINGDON MD
21009-1283
US

IV. Provider business mailing address

100 WALTER WARD BLVD STE 100
ABINGDON MD
21009-1283
US

V. Phone/Fax

Practice location:
  • Phone: 443-347-4700
  • Fax: 443-643-4707
Mailing address:
  • Phone: 443-347-4700
  • Fax: 443-643-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR195237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: