Provider Demographics
NPI:1255501607
Name:LANDERS, THOMAS JUSTIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JUSTIN
Last Name:LANDERS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 CORKTREE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2401
Mailing Address - Country:US
Mailing Address - Phone:832-212-5924
Mailing Address - Fax:
Practice Address - Street 1:8601 WALTHER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3036
Practice Address - Country:US
Practice Address - Phone:410-663-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist