Healthcare Provider Details

I. General information

NPI: 1205252798
Provider Name (Legal Business Name): MARY DEARSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2014
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 GUILFORD RD SUITE 240
COLUMBIA MD
21046-2651
US

IV. Provider business mailing address

13995 TRIADELPHIA RD
GLENELG MD
21737-9732
US

V. Phone/Fax

Practice location:
  • Phone: 443-393-2650
  • Fax:
Mailing address:
  • Phone: 443-812-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02066
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: