Provider Demographics
NPI:1134512197
Name:SHANK, ELIZABETH ANN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SHANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7250 PARKWAY DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:
Practice Address - Street 1:7250 PARKWAY DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006216363A00000X
MDC05721363AM0700X
MDC0005721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant