Provider Demographics
NPI:1578189650
Name:MARU, EMILY ALAINE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ALAINE
Last Name:MARU
Suffix:
Gender:
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ALAINE
Other - Last Name:MORMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10200 GRAND CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 BESTGATE RD STE 235
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3656
Practice Address - Country:US
Practice Address - Phone:443-231-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC08480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant