MEDICARE: MARISSA JANISH MOSHONISIOTIS MAOM, LAC, CCH

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	U02103	MD

General Provider Information

NPI Number	:	1528493129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA JANISH MOSHONISIOTIS MAOM, LAC, CCH

Provider Business Mailing Address
First Line	:	9801 FINSBURY RD
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4950
Country	:	US
Telephone Number	:	605-228-4116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 DULANEY VALLEY RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2702
Country	:	US
Telephone Number	:	605-228-4116
Fax Number	:

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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