Provider Demographics
NPI:1447974621
Name:POITRAS, JUSTINE (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:POITRAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 FELICIA CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2539
Mailing Address - Country:US
Mailing Address - Phone:443-841-9689
Mailing Address - Fax:
Practice Address - Street 1:10755 FALLS RD STE 160
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4588
Practice Address - Country:US
Practice Address - Phone:410-583-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC08626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant