=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295019230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A&M FIRST ASSISTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2011
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19106 PEACH BLOSSOM CT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20879-4979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-613-6440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19106 PEACH BLOSSOM CT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20879-4979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-613-6440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGICAL PHYSICIAN ASSISTANT
-----------------------------------------------------
Name | MS. MARIA ELENA MARCOS ESPINA
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 301-613-6440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | C0001066
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------