MEDICARE: MR. PETER HENNIG L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	U-01161	MD

General Provider Information

NPI Number	:	1336288653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER HENNIG L.AC.

Provider Business Mailing Address
First Line	:	202 WALNUT ST
Second Line	:
City	:	CHURCH HILL
State	:	MD
Zip	:	21623-1408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 WALNUT ST
Second Line	:
City	:	CHURCH HILL
State	:	MD
Zip	:	21623-1408
Country	:	US
Telephone Number	:	410-703-4431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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