Healthcare Provider Details

I. General information

NPI: 1730433301
Provider Name (Legal Business Name): LAURA LYSK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

IV. Provider business mailing address

230 WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-4424
  • Fax: 410-876-5330
Mailing address:
  • Phone: 410-848-4424
  • Fax: 410-876-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004898
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: