Provider Demographics
NPI:1154665362
Name:LASOR, KRISTEN (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LASOR
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 1:5301 BRABANT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3130
Mailing Address - Country:US
Mailing Address - Phone:443-223-1576
Mailing Address - Fax:
Practice Address - Street 1:2850 N RIDGE RD
Practice Address - Street 2:SUITE107B
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3464
Practice Address - Country:US
Practice Address - Phone:443-223-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist