Individual
VIKTORYIA PUSTAVOITAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
620 W LEXINGTON ST STE 5110, BALTIMORE, MD 21201-1508
(410) 777-1881
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C08193
MD
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
10/24/2020
Last updated
11/04/2024
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