Collaboration Agreement No:
8378
Confirmation No:
8378_3958C0008869
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Urgent Care-Medstar
Facility
MedStar Health: Urgent Care in Alexandria
Address
3610 King St.
Alexandria
VA 22302
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: 4660 Wilkens Ave, Suite 100, Baltimore, MD 21229
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