Provider Demographics
NPI:1265677561
Name:AMARAL KORANGY, DALE JEAN (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:JEAN
Last Name:AMARAL KORANGY
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:AMARAL
Other - Last Name:KORANGY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MAC
Mailing Address - Street 1:224 MAYO RD STE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2951
Mailing Address - Country:US
Mailing Address - Phone:410-269-6032
Mailing Address - Fax:
Practice Address - Street 1:224 MAYO RD STE E
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2951
Practice Address - Country:US
Practice Address - Phone:410-269-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist