Healthcare Provider Details

I. General information

NPI: 1306939095
Provider Name (Legal Business Name): AMY ELIZABETH WATERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH WATERS RD

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR SUITE 201
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

6410 ROCKLEDGE DR SUITE 201
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-8300
  • Fax:
Mailing address:
  • Phone: 301-530-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003046
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003046
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0003046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: