Healthcare Provider Details

I. General information

NPI: 1801553425
Provider Name (Legal Business Name): THERESA E MAROLDA M.AC., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8975 GUILFORD RD STE 170
COLUMBIA MD
21046-2389
US

IV. Provider business mailing address

10951 SCAGGSVILLE RD
LAUREL MD
20723-1007
US

V. Phone/Fax

Practice location:
  • Phone: 301-875-2672
  • Fax:
Mailing address:
  • Phone: 301-875-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: