Provider Demographics
NPI:1609050855
Name:DUBROVICH, JOY D (PA C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:D
Last Name:DUBROVICH
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:D
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3260
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-730-1617
Practice Address - Street 1:10710 CHARTER DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3260
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-730-1617
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03674363A00000X
MDC0003674363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical