Collaboration Agreement No:
3813
Confirmation No:
3813_1805C0005460
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Private Practice / Outpatient Clinic
Address
8507 Oxon Hill Rd
Fort Washington
MD 20744-4766
Is this the location where a copy of your collaboration agreement is on file? YES
A copy (paper or electronic) must be immediately available upon request by the Board.
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
NO
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO