Provider Demographics
NPI:1083763247
Name:WURZEL, DAVID ROBIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBIN
Last Name:WURZEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4688
Mailing Address - Country:US
Mailing Address - Phone:443-812-1665
Mailing Address - Fax:
Practice Address - Street 1:8370 COURT AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4688
Practice Address - Country:US
Practice Address - Phone:443-812-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist