Healthcare Provider Details

I. General information

NPI: 1942431689
Provider Name (Legal Business Name): DANIELLE CHRISTINE DREZEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST N2W77 DIAGNOSTIC RADIOLOGY
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

11527 TUSCANY DR
LAUREL MD
20708-2874
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3477
  • Fax:
Mailing address:
  • Phone: 401-742-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: