Provider Demographics
NPI:1013389683
Name:VASOLD, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:VASOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ABERDEEN SHOPPING PLZ
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2247
Mailing Address - Country:US
Mailing Address - Phone:410-272-8844
Mailing Address - Fax:410-272-8910
Practice Address - Street 1:16 ABERDEEN SHOPPING PLZ
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2247
Practice Address - Country:US
Practice Address - Phone:410-272-8844
Practice Address - Fax:410-272-8910
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05979363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical