Provider Demographics
NPI:1376510693
Name:OUTTEN, DOROTHY RANSON (PA-C)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:RANSON
Last Name:OUTTEN
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:LIFELINE URGENT CARE OF RANDALLSTOWN
Mailing Address - Street 2:8507 LIBERTY ROAD
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:410-496-9105
Mailing Address - Fax:410-496-9109
Practice Address - Street 1:LIFELINE URGENT CARE OF RANDALLSTOWN
Practice Address - Street 2:8507 LIBERTY ROAD
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:410-496-9105
Practice Address - Fax:410-496-9109
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000871363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0000871OtherPA CERTIFICATE