Provider Demographics
NPI:1699069310
Name:SUMNER, EMILY E (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:E
Other - Last Name:WOLLENWEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5965 EXCHANGE DR STE A-B
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9254
Mailing Address - Country:US
Mailing Address - Phone:410-552-8126
Mailing Address - Fax:443-458-7220
Practice Address - Street 1:5965 EXCHANGE DR STE A-B
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9254
Practice Address - Country:US
Practice Address - Phone:410-552-8126
Practice Address - Fax:443-458-7220
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MDC0004815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD389945ZDDBMedicare PIN
MD389915YWV2Medicare PIN
MD389945YVZMedicare PIN