Provider Demographics
NPI:1164768701
Name:GANDY, PAMELA R (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:GANDY
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 1:6115 TIMOTHY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3861
Mailing Address - Country:US
Mailing Address - Phone:410-964-1731
Mailing Address - Fax:410-964-1731
Practice Address - Street 1:6115 TIMOTHY CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3861
Practice Address - Country:US
Practice Address - Phone:410-964-1731
Practice Address - Fax:410-964-1731
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist