Collaboration Agreement No:
3938
Confirmation No:
3938_1901C0008335
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Nursing Home/Long Term Care Facility
Facility
Patapsco Healthcare
Address
9109 Liberty Road
Randallstown
MD 21133
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: 3406 Hatton Rd Baltimore, MD 21208
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