Collaboration Agreement No:
5432
Confirmation No:
5432_2259C0005925
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
MedStar eVisit - Telehealth
Facility
MedStar eVisit - Telehealth
Address
10980 Grantchester Way, 7th Floor
Columbia
MD 21044
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?
YES
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO