Provider Demographics
NPI:1912974635
Name:ZARZUELA, STACY M (PA)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:ZARZUELA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:6503 DEER POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1674
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC02917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S135S059Medicare PIN