Provider Demographics
NPI:1093593972
Name:BUSKIRK, LIESL MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:MARIE
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 CARRBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1812
Mailing Address - Country:US
Mailing Address - Phone:801-310-1155
Mailing Address - Fax:
Practice Address - Street 1:7226 LEE DEFOREST DR STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3238
Practice Address - Country:US
Practice Address - Phone:443-333-5233
Practice Address - Fax:443-333-5232
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant