Healthcare Provider Details

I. General information

NPI: 1821304817
Provider Name (Legal Business Name): ELLEN LOUISE CURRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 STAYTON DR STE D
JESSUP MD
20794-9615
US

IV. Provider business mailing address

8106 STAYTON DR STE D
JESSUP MD
20794-9615
US

V. Phone/Fax

Practice location:
  • Phone: 301-520-1673
  • Fax: 866-289-9771
Mailing address:
  • Phone: 301-520-1673
  • Fax: 866-289-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0000733
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: