Healthcare Provider Details

I. General information

NPI: 1124599964
Provider Name (Legal Business Name): AARON EXUM LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 W PATRICK ST STE 4
FREDERICK MD
21701-6910
US

IV. Provider business mailing address

245 WASHINGTON ST
FREDERICK MD
21701-6518
US

V. Phone/Fax

Practice location:
  • Phone: 240-285-9045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: