Provider Demographics
NPI:1073744686
Name:WUERDEMANN, STAR E (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:E
Last Name:WUERDEMANN
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 SCHENLEY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2525
Mailing Address - Country:US
Mailing Address - Phone:443-745-5456
Mailing Address - Fax:
Practice Address - Street 1:4643 SCHENLEY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2525
Practice Address - Country:US
Practice Address - Phone:443-745-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1623171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist