Provider Demographics
NPI:1790955839
Name:PARKER, DEIDRE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:D
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST STE 600
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5827
Practice Address - Country:US
Practice Address - Phone:443-849-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant