MEDICARE: ELLICOTT CIR ACUPUNCTURE LLC

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	U02370	MD

General Provider Information

NPI Number	:	1528544079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLICOTT CIR ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	10569 OLD ELLICOTT CIR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2277
Country	:	US
Telephone Number	:	443-756-0563
Fax Number	:	888-885-9685

Provider Business Practice Location Address
First Line	:	5054 DORSEY HALL DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7744
Country	:	US
Telephone Number	:	443-756-0563
Fax Number	:	888-885-9685

Authorized Official
Title or Position	:	DR.
Name	:	JINFANG MA
Credential	:	PHD
Telephone Number	:	443-756-0563

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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