Provider Demographics
NPI:1164109815
Name:AUSTIN-BRAXTON, THOMAS (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:AUSTIN-BRAXTON
Suffix:
Gender:M
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 OLD HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6313
Mailing Address - Country:US
Mailing Address - Phone:410-870-4787
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD STE 800
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-800-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist