Provider Demographics
NPI:1285634329
Name:ZELESNICK, LORRIE BARBARA (PA C)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:BARBARA
Last Name:ZELESNICK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SETON DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3210
Mailing Address - Country:US
Mailing Address - Phone:410-358-3410
Mailing Address - Fax:
Practice Address - Street 1:4800 SETON DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3210
Practice Address - Country:US
Practice Address - Phone:410-358-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC000054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS238H643OtherPTAN
MD1285634329OtherMEDICARE NPI
MD257834ZBAKOtherPTAN
MD257834ZBAKOtherPTAN
P16395Medicare UPIN