Healthcare Provider Details

I. General information

NPI: 1639393390
Provider Name (Legal Business Name): STEPHANIE JUDGE L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10723 COLUMBIA PIKE STE B
SILVER SPRING MD
20901-4445
US

IV. Provider business mailing address

6241 IRONWOOD WAY
COLUMBIA MD
21045-4466
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-3730
  • Fax: 301-754-3731
Mailing address:
  • Phone: 443-540-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01265
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: