Healthcare Provider Details

I. General information

NPI: 1003552597
Provider Name (Legal Business Name): SARAH MOON L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN AVE SW
GLEN BURNIE MD
21061-3864
US

IV. Provider business mailing address

101 MAIN AVE SW
GLEN BURNIE MD
21061-3864
US

V. Phone/Fax

Practice location:
  • Phone: 240-707-7774
  • Fax:
Mailing address:
  • Phone: 240-707-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02799
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: