Healthcare Provider Details

I. General information

NPI: 1962525048
Provider Name (Legal Business Name): JOAN M LUSBY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WASHINGTON RD HUNTER PROFESSIONAL CENTER
WESTMINSTER MD
21157-5827
US

IV. Provider business mailing address

2973 MANCHESTER RD HUNTER PROFESSIONAL CENTER
MANCHESTER MD
21102-1802
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-1888
  • Fax: 410-795-3538
Mailing address:
  • Phone: 410-374-4747
  • Fax: 443-507-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: