Healthcare Provider Details

I. General information

NPI: 1063232536
Provider Name (Legal Business Name): LAUREN WHITTAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 BELAIR RD
NOTTINGHAM MD
21236-4088
US

IV. Provider business mailing address

7602 BELAIR RD
NOTTINGHAM MD
21236-4088
US

V. Phone/Fax

Practice location:
  • Phone: 410-663-8100
  • Fax: 410-663-8119
Mailing address:
  • Phone: 410-663-8100
  • Fax: 410-663-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009635
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: