Provider Demographics
NPI:1164607354
Name:COLABELLA, MICHELLE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:COLABELLA
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 1:7016 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1711
Mailing Address - Country:US
Mailing Address - Phone:443-812-8451
Mailing Address - Fax:410-654-8449
Practice Address - Street 1:8 GREENSPRING VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4136
Practice Address - Country:US
Practice Address - Phone:410-654-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist