MEDICARE: SUSAN DAVIS L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC24	DC
2	171100000X	Acupuncturist	U284	MD

General Provider Information

NPI Number	:	1396920815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DAVIS L.AC.

Provider Business Mailing Address
First Line	:	7106 WOODLAND AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4565
Country	:	US
Telephone Number	:	301-275-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 CONNECTICUT AVE NW STE 223
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5702
Country	:	US
Telephone Number	:	202-244-8824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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Directions to “ SUSAN DAVIS L.AC.” Practice Location

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