Collaboration Agreement No:
2250
Confirmation No:
2250_1338C0008084
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Private Practice / Outpatient Clinic
Facility
GW Center for Integrative Medicine
Address
908 New Hampshire Ave NW Suite #200
Washington
DC 20037
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: 1616 BLACKSMITH WAY Frederick Maryland
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