Provider Demographics
NPI:1770896532
Name:ADRIEN, JUSTIN G (PA-C)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:G
Last Name:ADRIEN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7671 QUARTERFIELD ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-766-0111
Mailing Address - Fax:410-582-9155
Practice Address - Street 1:7671 QUARTERFIELD ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-766-0111
Practice Address - Fax:410-582-9155
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2013-10-15
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
MDC0004412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant