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General NPI Number Information
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NPI Number | 1093997652
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Entity Type | Individual
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Provider Name | MARILYN ANN BURDEKIN LIC. ACUPUNCTURIST
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Gender | Female
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 9170 ROUTE 108 STE 202
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City | COLUMBIA
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State | MD
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Zip | 21045-1988
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Country | US
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Telephone | 410-491-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 RAMS HORN ROW
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-5981
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Country | US
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Telephone | 410-491-6206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | U01074
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License Number State | MD
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