Provider Demographics
NPI:1285814780
Name:AIRPARK PRIMARY CARE LLC
Entity Type:Organization
Organization Name:AIRPARK PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-848-8882
Mailing Address - Street 1:125 AIRPORT DR
Mailing Address - Street 2:SUITE 34
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3024
Mailing Address - Country:US
Mailing Address - Phone:410-848-8882
Mailing Address - Fax:410-848-8767
Practice Address - Street 1:125 AIRPORT DR
Practice Address - Street 2:SUITE 34
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3024
Practice Address - Country:US
Practice Address - Phone:410-848-8882
Practice Address - Fax:410-848-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty