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General NPI Number Information
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NPI Number | 1689013740
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Entity Type | Organization
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Legal Business Name | EDGEWATER ACUPUNCTURE LLC
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 153 MAYO RD SUITE 5
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City | EDGEWATER
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State | MD
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Zip | 21037-1852
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Country | US
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Telephone | 443-540-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 153 MAYO RD SUITE 5
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City | EDGEWATER
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State | MD
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Zip | 21037-1852
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Country | US
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Telephone | 443-540-3350
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MEAGHAN MASSELLA WALKER
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Credential | M.AC, L.AC, DIPL. AC
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Telephone | 443-540-3350
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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 | U01597
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02034
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01561
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License Number State | MD
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