MEDICARE: MANDY RACHUBA CRIADO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C03177	MD

General Provider Information

NPI Number	:	1902955271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY RACHUBA CRIADO PA-C

Provider Business Mailing Address
First Line	:	1447 YORK RD STE 102
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6074
Country	:	US
Telephone Number	:	667-214-1171
Fax Number	:	410-337-5107

Provider Business Practice Location Address
First Line	:	1447 YORK RD STE 102
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6074
Country	:	US
Telephone Number	:	667-214-1171
Fax Number	:	410-337-5107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	10/21/2025

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