Provider Demographics
NPI:1578189650
Name:MARU, EMILY ALAINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ALAINE
Last Name:MARU
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ALAINE
Other - Last Name:MORMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15401 RAVENGLASS LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8999
Mailing Address - Country:US
Mailing Address - Phone:618-406-8529
Mailing Address - Fax:
Practice Address - Street 1:15401 RAVENGLASS LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8999
Practice Address - Country:US
Practice Address - Phone:618-406-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant