Provider Demographics
NPI:1457379299
Name:LOVE, PATRICIA A (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:LOVE
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 1:301 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:503 A MUIR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613
Practice Address - Country:US
Practice Address - Phone:410-228-4045
Practice Address - Fax:410-221-6457
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002407363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherTRICARE
MD521116591OtherCOVENTRY
MD521116591OtherINFORMED
MD750698OtherNCPPO
S135O184Medicare PIN
MD521116591OtherINFORMED