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General NPI Number Information
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NPI Number | 1972664241
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Entity Type | Individual
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Provider Name | SARA LEE ELIJAH L.AC.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 176 THOMAS JOHNSON DR STE 204
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City | FREDERICK
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State | MD
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Zip | 21702-4538
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Country | US
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Telephone | 410-967-1773
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Fax |
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Provider Business Mailing Address
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Address Line | 2703 EGRET WAY
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City | FREDERICK
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State | MD
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Zip | 21701-1913
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Country | US
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Telephone | 410-967-1773
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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 | U 01125
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License Number State | MD
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