Provider Demographics
NPI:1003552597
Name:MOON, SARAH (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 FOUNTAIN GRN S
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2101
Mailing Address - Country:US
Mailing Address - Phone:240-707-7774
Mailing Address - Fax:
Practice Address - Street 1:3397 FOUNTAIN GRN S
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2101
Practice Address - Country:US
Practice Address - Phone:240-707-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02799171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist