=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154518496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENNY S. TODD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2007
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2411 CROFTON LN SUITE 17A
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-721-5742
-----------------------------------------------------
Fax | 410-982-6476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2411 CROFTON LN SUITE 17A
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-721-5742
-----------------------------------------------------
Fax | 410-982-6476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | MS. PENNY STEWART TODD
-----------------------------------------------------
Credential | M.AC., L.AC.
-----------------------------------------------------
Telephone | 410-721-5742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U01046
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------