Provider Demographics
NPI:1174647705
Name:CHAMPION, MAUREEN VIOLET (LAC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:VIOLET
Last Name:CHAMPION
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 1:4950 COLUMBIA RD APT 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2181
Mailing Address - Country:US
Mailing Address - Phone:410-884-8576
Mailing Address - Fax:
Practice Address - Street 1:9170 STATE HIGHWAY 108
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-707-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist