Provider Demographics
NPI:1215408083
Name:DUDA, LAUREN (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DUDA
Suffix:
Gender:F
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 1:21 TROJAN HORSE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1345
Mailing Address - Country:US
Mailing Address - Phone:443-791-1537
Mailing Address - Fax:
Practice Address - Street 1:2000 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1595
Practice Address - Country:US
Practice Address - Phone:443-791-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02541OtherACUPUNCTURE LICENSE