Provider Demographics
NPI:1265738660
Name:DEWLIN, LAUREN JOONG-MEE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JOONG-MEE
Last Name:DEWLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FILA WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9452
Mailing Address - Country:US
Mailing Address - Phone:410-472-1006
Mailing Address - Fax:410-472-0900
Practice Address - Street 1:10 FILA WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9452
Practice Address - Country:US
Practice Address - Phone:410-472-1006
Practice Address - Fax:410-472-0900
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant