MEDICARE: MINDFULNESS COMMUNITY ASSOCIATION, INC

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	U02300	MD

General Provider Information

NPI Number	:	1710330584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFULNESS COMMUNITY ASSOCIATION, INC

Provider Business Mailing Address
First Line	:	5627 ALLENTOWN RD
Second Line	:	SUITE 101-102
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746-4520
Country	:	US
Telephone Number	:	301-678-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5627 ALLENTOWN RD
Second Line	:	SUITE 101-102
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746-4520
Country	:	US
Telephone Number	:	301-678-9411
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MINH THU NGUYEN
Credential	:	LAC
Telephone Number	:	240-389-3919

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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