AMANDA R SQUARE (Credential# 979221) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
AMANDA R SQUARE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.050057. The credential type is physician/surgeon. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 2501 Valley View Way, Ellicott City, MD 21043. The current status is active.
| Licensee Name | AMANDA R SQUARE |
| Credential ID | 979221 |
| Credential Number | 1.050057 |
| Credential Type | Physician/Surgeon |
| Business Address |
2501 Valley View Way Ellicott City MD 21043 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2011-06-30 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-01-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 975263 | CSP.0049351 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2010-12-09 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 2501 Valley View Way |
| City | Ellicott City |
| State | MD |
| Zip Code | 21043 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jane M Rohde | 737 Oella Avenue, Ellicott City, MD 21043 | Architect | 2020-08-01 ~ 2021-07-31 |
| Sandee L Gelven | 8038 White Jasmine Ct, Ellicott City, MD 21043 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Atesha N Woods | 4930 Walking Stick Road, Ellicott City, MD 21043 | Licensed Clinical Social Worker | 2020-04-01 ~ 2021-03-31 |
| Humphrey K Kariuki | 4129 Brittany Dr, Ellicott City, MD 21043 | Professional Engineer | 2019-02-01 ~ 2020-01-31 |
| Margaret S Sheehan | 5395 Dunteachin Dr, Ellicott City, MD 21043 | Professional Engineer | 2019-02-01 ~ 2020-01-31 |
| Sadi H Wadi | 8608 Golden Grain Ct, Ellicott City, MD 21043 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Robert C Smith | 3607 Old Manse Ct, Ellicott City, MD 21043 | Professional Engineer | 2014-02-01 ~ 2015-01-31 |
| Shazia Ali | 8402 Timberland Circle, Ellicott City, MD 21043 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Zbigniew Golonka | 8764 Stonehouse Dr., Ellicott City, MD 21043 | Psychologist | 2020-01-01 ~ 2020-12-31 |
| Donna M Soucy Zarzuela | 4505 Rebecca Court, Ellicott City, MD 21043 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Find all Licenses in zip 21043 | |||
| City | Ellicott City |
| Zip Code | 21043 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Ellicott City |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Dawn A Lukose | 611 Bernice Rd, Franklin Square, NY 11010-1801 | Physician/surgeon | ~ |
| Ki S Yoo | 2237 Asbury Square, Atlanta, GA 30346 | Physician/surgeon | 2002-07-02 ~ 2003-08-31 |
| Rachelle V. Dyquiangco | 1 Herald Square, New Britain, CT 06051 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Eileen K Plotkin | 1 Liberty Square, New Britain, CT 06051 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Edward P Toffolon | 1 Liberty Square, New Britain, CT 06051 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Ding Wen Wu | 895 Stewart Place, Franklin Square, NY 11010 | Physician/surgeon | 2008-08-07 ~ 2009-09-30 |
| Sudhir K Bhatnagar Md | One Liberty Square, New Britain, CT 06051-2637 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Kevin S Tomany | 31 Village Square, Chelmsford, MA 01824 | Physician/surgeon | 1999-05-27 ~ 2000-05-31 |
| Tessa Balach Md | 20 Liberty Square #277, Bloomfield, CT 06002 | Physician/surgeon | 2018-03-01 ~ 2019-02-28 |
| Lawrence I Deckelbaum | 911 Merion Square Rd, Gladwyne, PA 19035 | Physician/surgeon | 1995-01-27 ~ 1996-02-29 |
Please comment or provide details below to improve the information on AMANDA R SQUARE.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).