Healthcare Provider Details

I. General information

NPI: 1295366839
Provider Name (Legal Business Name): MARK FREDERICK GREINER L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 160
COLUMBIA MD
21045-5336
US

IV. Provider business mailing address

7603 CENTRAL AVE
TAKOMA PARK MD
20912-6446
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-9922
  • Fax:
Mailing address:
  • Phone: 301-920-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02710
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: