MEDICARE: MS. JACQUELINE DEBORAH BARRY LIC.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	U02025	MD

General Provider Information

NPI Number	:	1619215308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE DEBORAH BARRY LIC.AC

Provider Business Mailing Address
First Line	:	11474 IAGER BLVD
Second Line	:
City	:	FULTON
State	:	MD
Zip	:	20759-2507
Country	:	US
Telephone Number	:	443-820-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	10705 CHARTER DR STE 420
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2800
Country	:	US
Telephone Number	:	443-820-8253
Fax Number	:

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

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	12/26/2018

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