Healthcare Provider Details

I. General information

NPI: 1457272163
Provider Name (Legal Business Name): JOSHUA DAVID ELLIOTT LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 MITCHELLS CHANCE RD
EDGEWATER MD
21037-2773
US

IV. Provider business mailing address

100 FIDDLERS HILL RD
EDGEWATER MD
21037-3613
US

V. Phone/Fax

Practice location:
  • Phone: 772-643-4468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03368
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: