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General NPI Number Information
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NPI Number | 1699135772
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Entity Type | Organization
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Legal Business Name | EXTRAORDINARY VESSELS TRADITIONAL ACUPUNCTURE
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 1233 DIETRICH WAY
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City | ANNAPOLIS
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State | MD
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Zip | 21409-5020
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Country | US
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Telephone | 410-980-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 DIETRICH WAY
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City | ANNAPOLIS
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State | MD
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Zip | 21409-5020
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Country | US
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Telephone | 410-980-1397
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/ OWNER
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Name | MS. DALE AMARAL KORANGY
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Credential | M.AC., L.AC.
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Telephone | 410-980-1397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | U00484
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License Number State | MD
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