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General NPI Number Information
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NPI Number | 1962767657
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Entity Type | Organization
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Legal Business Name | R4, LLC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 424 BARNES ST 2ND FLOOR
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City | BEL AIR
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State | MD
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Zip | 21014-3958
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Country | US
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Telephone | 410-638-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 424 BARNES ST 2ND FLOOR
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City | BEL AIR
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State | MD
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Zip | 21014-3958
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Country | US
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Telephone | 410-638-5544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUSAN CHAMBERLAIN
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Credential |
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Telephone | 410-638-5544
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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 | U01599
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License Number State | MD
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