Collaboration Agreement No:
4287
Confirmation No:
4287_2144C0007005
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Private Practice / Outpatient Clinic
Facility
Chesapeake Urology- Westminster
Address
410 Malcolm Drive Suite A
Westminster
MD 21157
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. Brad Douglas Lerner | License No: D0034608