Healthcare Provider Details

I. General information

NPI: 1649091802
Provider Name (Legal Business Name): QUN ZHOU OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 ANNAPOLIS RD STE E
ODENTON MD
21113-1398
US

IV. Provider business mailing address

10173 BRACKEN DR
ELLICOTT CITY MD
21042-1675
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-5726
  • Fax:
Mailing address:
  • Phone: 443-703-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: