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General NPI Number Information
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NPI Number | 1942679709
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Entity Type | Individual
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Provider Name | JILL EMILY O'MALLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 910 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4516
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Country | US
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Telephone | 410-644-1880
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Fax | 410-646-3623
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Provider Business Mailing Address
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Address Line | 910 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4516
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Country | US
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Telephone | 410-644-1880
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Fax | 410-646-3623
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C07627
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C07627
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License Number State | MD
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