Provider Demographics
NPI:1679821268
Name:SPRADLIN, AMBER L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-9988
Mailing Address - Fax:
Practice Address - Street 1:80 SHERRY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3232
Practice Address - Country:US
Practice Address - Phone:410-414-9229
Practice Address - Fax:410-414-9339
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2017-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0004821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0004821OtherSTATE LICENSE