Healthcare Provider Details

I. General information

NPI: 1942201991
Provider Name (Legal Business Name): RORY RICHARD PRICE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RORY RICHARD PRICE PA-C

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24441 GARRETT HWY
MC HENRY MD
21541-1311
US

IV. Provider business mailing address

PO BOX 1671
CUMBERLAND MD
21501-1671
US

V. Phone/Fax

Practice location:
  • Phone: 301-387-8718
  • Fax:
Mailing address:
  • Phone: 240-964-8342
  • Fax: 240-964-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC05043
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA050736
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050736
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1486
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: