Provider Demographics
NPI:1265620272
Name:LEVASSEUR, KAREN L (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:WITTMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:115 S PINEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2619
Mailing Address - Country:US
Mailing Address - Phone:668-389-2727
Mailing Address - Fax:
Practice Address - Street 1:115 S PINEY RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2619
Practice Address - Country:US
Practice Address - Phone:668-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant