Provider Demographics
NPI:1053848788
Name:POOLE, ASHLEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8974 MAR LYNN DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2465
Mailing Address - Country:US
Mailing Address - Phone:443-359-2099
Mailing Address - Fax:410-742-4804
Practice Address - Street 1:106 MILFORD ST STE 103
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6966
Practice Address - Country:US
Practice Address - Phone:410-749-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC007791363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical