Healthcare Provider Details

I. General information

NPI: 1891936233
Provider Name (Legal Business Name): BOBBI MEAD ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 OPOSSUMTOWN PIKE SUITE 25
FREDERICK MD
21702-4748
US

IV. Provider business mailing address

4920 JEFFERSON PIKE
FREDERICK MD
21703-6912
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-9111
  • Fax: 301-695-9115
Mailing address:
  • Phone: 301-695-9111
  • Fax: 301-695-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01482
License Number StateMD

VIII. Authorized Official

Name: MRS. ROBERTA MEAD
Title or Position: OWNER
Credential: LAC
Phone: 301-695-9111