Provider Demographics
NPI:1992057194
Name:CONDON, LAUREN RINACA (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RINACA
Last Name:CONDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 TEXAS STATION COURT, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-683-4102
Mailing Address - Fax:410-683-2130
Practice Address - Street 1:1 TEXAS STATION COURT, SUITE 300
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-683-4102
Practice Address - Fax:410-683-2130
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004876363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical