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General NPI Number Information
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NPI Number | 1508263161
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Entity Type | Individual
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Provider Name | RAYMOND SHAW L.AC
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Gender | Male
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 1100 W PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21703-3902
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Country | US
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Telephone | 301-662-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 7402 SKYLINE DR
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City | FREDERICK
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State | MD
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Zip | 21702-3652
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Country | US
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Telephone | 703-509-7657
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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 | U02131
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License Number State | MD
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