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General NPI Number Information
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NPI Number | 1063101913
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Entity Type | Organization
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Legal Business Name | ANCIENT ARTS ACUPUNCTURE A CLOSE PC
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 907 S LAKEWOOD AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3815
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Country | US
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Telephone | 443-869-6584
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Fax | 443-869-6127
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Provider Business Mailing Address
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Address Line | 907 S LAKEWOOD AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3815
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Country | US
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Telephone | 443-869-6584
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Fax | 443-869-6127
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS INGEGNO
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Credential | LAC
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Telephone | 443-869-6584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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