Provider Demographics
NPI:1487731048
Name:VANDERWERKE, JOAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:VANDERWERKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11722 REISTERSTOWN RD
Mailing Address - Street 2:IMMEDIATE CARE
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3302
Mailing Address - Country:US
Mailing Address - Phone:410-833-5000
Mailing Address - Fax:410-833-1433
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:SUITE 100 ENDOSCOPIC MICROSURGERY ASS. PA
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-494-1846
Practice Address - Fax:410-828-1706
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001281-1363A00000X
MDC0000813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant