Provider Demographics
NPI:1780814251
Name:PARRA, JORGE E (C-SA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:PARRA
Suffix:
Gender:M
Credentials:C-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 PROCOPIO CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1645
Mailing Address - Country:US
Mailing Address - Phone:410-381-2670
Mailing Address - Fax:
Practice Address - Street 1:7253 PROCOPIO CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1645
Practice Address - Country:US
Practice Address - Phone:410-381-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical