Provider Demographics
NPI:1104927748
Name:COBB, ANN-MARIE NATALEE (PA-C)
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:NATALEE
Last Name:COBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANN-MARIE
Other - Middle Name:NATALEE
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3721 HALLOWAY N
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3213
Mailing Address - Country:US
Mailing Address - Phone:202-904-8599
Mailing Address - Fax:
Practice Address - Street 1:701 EAST CHARLES STREET
Practice Address - Street 2:
Practice Address - City:LAPLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-609-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC-0003406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant