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General NPI Number Information
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NPI Number | 1366008179
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Entity Type | Organization
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Legal Business Name | BALTIMORE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 1501 SULGRAVE AVE STE 310
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City | BALTIMORE
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State | MD
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Zip | 21209-3654
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Country | US
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Telephone | 443-254-6841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5364
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City | BALTIMORE
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State | MD
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Zip | 21209-0364
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Country | US
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Telephone | 443-254-6841
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | MS. LISA BEACH
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Credential | L.AC., M.AC.
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Telephone | 443-254-6841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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