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General NPI Number Information
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NPI Number | 1386194017
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Entity Type | Individual
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Provider Name | MARIE ELISE DERRICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 201 E UNIVERSITY PKWY
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City | BALTIMORE
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State | MD
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Zip | 21218-2829
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Country | US
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Telephone | 410-554-2608
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Fax |
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Provider Business Mailing Address
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Address Line | WHC PHYSICIAN GROUP LLC PO BOX 418283
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City | BOSTON
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State | MA
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Zip | 02241-0001
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Country | US
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Telephone | 703-558-1544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0006251
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License Number State | MD
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