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General NPI Number Information
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NPI Number | 1417993205
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Entity Type | Individual
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Provider Name | LISA M QUARLES PA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 5401 OLD COURT ROAD NORTHWEST HOSPITAL
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City | RANDALLSTOWN
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State | MD
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Zip | 21133
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Country | US
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Telephone | 410-521-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 5236 KINGSBROOK DRIVE
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City | FREDERICK
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State | MD
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Zip | 21703
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Country | US
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Telephone | 301-696-1389
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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 | C0002523
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License Number State | MD
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