Collaboration Agreement No:
7787
Confirmation No:
7787_3527C0001911
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Facility
Northwest Hospital Center
Address
5401 Old Court 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: 10200 Grand Central Ave Suite 220, Owings Mills, MD 21117
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?
YES
Physician's Name: Dr. Brad Douglas Lerner | License No: D0034608