Basic Information
| Provider Information | |||||||||
| NPI: | 1679821268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPRADLIN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 196 THOMAS JOHNSON DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016689988 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 SHERRY LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206783232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104149229 | ||||||||
| FaxNumber: | 4104149339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0004821 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | C0004821 | 01 | MD | STATE LICENSE | OTHER |