Provider Demographics
NPI:1972655520
Name:DEMBECK, MICHAEL EWALD (PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EWALD
Last Name:DEMBECK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 CLIFFVALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1007
Mailing Address - Country:US
Mailing Address - Phone:410-371-9550
Mailing Address - Fax:
Practice Address - Street 1:900 S CATON AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-368-2000
Practice Address - Fax:410-368-2009
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00940363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical