Collaboration Agreement No:
7557
Confirmation No:
7557_3340C0009442
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Facility
Johns Hopkins Howard County Medical Center
Address
5755 Cedar Lane
Columbia
MD 21044
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 Avenue, 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. Frank M Nezu | License No: D0061143