Provider Demographics
NPI:1700886165
Name:GARDE, MARIA THERESIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:THERESIA
Last Name:GARDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:THERESIA
Other - Last Name:LYDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:31413 WINTERPLACE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1877
Practice Address - Country:US
Practice Address - Phone:410-860-0100
Practice Address - Fax:410-860-4894
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid