Healthcare Provider Details

I. General information

NPI: 1598087009
Provider Name (Legal Business Name): NANY CONDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 TIDEWATER COLONY DR SUITE 1-A
ANNAPOLIS MD
21401-2101
US

IV. Provider business mailing address

15602 PLAID DR
LAUREL MD
20707-5319
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 301-275-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: