Healthcare Provider Details

I. General information

NPI: 1841314176
Provider Name (Legal Business Name): SUSAN MAPES GUERINO L.AC., M.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9170 STATE ROUTE 108 STE 202
COLUMBIA MD
21045-1917
US

IV. Provider business mailing address

29 WELLSPRING DR
BEAR DE
19701-1360
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2700
  • Fax:
Mailing address:
  • Phone: 302-832-7459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01058
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: