Healthcare Provider Details

I. General information

NPI: 1912974635
Provider Name (Legal Business Name): STACY M ZARZUELA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 DEER POINTE DR STE A
SALISBURY MD
21804-1674
US

IV. Provider business mailing address

9601 PULASKI PARK DR SUITE 416
BALTIMORE MD
21220-1409
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax:
Mailing address:
  • Phone: 410-933-5678
  • Fax: 410-933-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC02917
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: