Healthcare Provider Details

I. General information

NPI: 1124349907
Provider Name (Legal Business Name): TODD MCCLOSKEY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W PATRICK ST
FREDERICK MD
21701-4855
US

IV. Provider business mailing address

111 E 8TH ST APT 3
FREDERICK MD
21701-4706
US

V. Phone/Fax

Practice location:
  • Phone: 484-995-7877
  • Fax:
Mailing address:
  • Phone: 484-995-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01747
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: