Healthcare Provider Details

I. General information

NPI: 1265635304
Provider Name (Legal Business Name): ERIC DASIE WOZNYSMITH L. AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BIGGS PURCHASE LN
LOTHIAN MD
20711-2300
US

IV. Provider business mailing address

230 BIGGS PURCHASE LN
LOTHIAN MD
20711-2300
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-0299
  • Fax:
Mailing address:
  • Phone: 410-956-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU-01268
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: