Provider Demographics
NPI:1194903138
Name:FLEMING, AMY MARIE (PAC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:9515 DEERECO ROAD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-449-2060
Mailing Address - Fax:
Practice Address - Street 1:9515 DEERECO ROAD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-449-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001585363A00000X
MDD74625207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine