Healthcare Provider Details

I. General information

NPI: 1932405735
Provider Name (Legal Business Name): EMILY RICHARDSON TRAUM PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

IV. Provider business mailing address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-4154
  • Fax: 410-860-9583
Mailing address:
  • Phone: 410-749-4154
  • Fax: 410-860-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004425
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: