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General NPI Number Information
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NPI Number | 1689123630
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Entity Type | Individual
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Provider Name | SARAH CAROLINE BAZYLUK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 7250 PARKWAY DR SUITE 500
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City | HANOVER
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State | MD
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Zip | 21076-1388
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Country | US
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Telephone | 443-949-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 4705 BRADLEY BLVD APT 106
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6315
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Country | US
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Telephone |
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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 | C0006239
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License Number State | MD
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