Collaboration Agreement No:
8369
Confirmation No:
8369_3951C0001911
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Facility
Umd Baltimore Washington Medical Center
Address
301 Hospital Drive
Glen Burnie
MD 21061
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?
NO