Collaboration Agreement No:
7803
Confirmation No:
7803_3536C0005955
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Facility
Medstar Harbor Hospital
Address
3001 South Hanover Street
Baltimore
MD 21225
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: MedStar Good Samaritan Hospital 5601 Loch Raven Blvd, Baltimore, MD 21239
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