Collaboration Agreement No:
5353
Confirmation No:
5353_2202C0006024
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Facility
UM Laurel Regional Health
Address
7150 Contee Rd
Laurel
MD 20707
Is this the location where a copy of your collaboration agreement is on file? NO
A copy (paper or electronic) must be immediately available upon request by the Board.
Location: 901 Harry S Truman Dr. N, Largo, MD 20774
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