Provider Demographics
NPI:1922317916
Name:O'LEARY, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:659 S SALISBURY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5453
Mailing Address - Country:US
Mailing Address - Phone:410-543-2020
Mailing Address - Fax:410-543-2302
Practice Address - Street 1:659 S SALISBURY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5453
Practice Address - Country:US
Practice Address - Phone:410-543-2020
Practice Address - Fax:410-543-2302
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical