Healthcare Provider Details

I. General information

NPI: 1306949813
Provider Name (Legal Business Name): MAUREEN ANNE PLOEN MA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY SUITE 150
ANNAPOLIS MD
21401-3046
US

IV. Provider business mailing address

2002 MEDICAL PARKWAY SUITE 150
ANNAPOLIS MD
21401-3046
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9000
  • Fax: 410-571-1670
Mailing address:
  • Phone: 410-451-1198
  • Fax: 410-451-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002673
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: