Provider Demographics
NPI:1629278338
Name:BUSUTTIL, CARMELINA ANNA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARMELINA
Middle Name:ANNA
Last Name:BUSUTTIL
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 1:22 S GREENE ST
Mailing Address - Street 2:SUITE S11B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-6040
Mailing Address - Fax:410-328-0534
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:SUITE S11B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6040
Practice Address - Fax:410-328-0534
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P55728Medicare UPIN