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Individual

SAU WIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5 BEL AIR SOUTH PKWY, BEL AIR, MD 21015-6091
(410) 569-0044
(410) 569-2331
Mailing address
5783 PARADISE AVE, ELKRIDGE, MD 21075-5118
(847) 219-4961

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0006871
MD

Other

Enumeration date
10/02/2018
Last updated
10/02/2018
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