Provider Demographics
NPI:1275771040
Name:BASTRESS, ROBERT L II (LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:BASTRESS
Suffix:II
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:1140 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5852
Mailing Address - Country:US
Mailing Address - Phone:240-420-8625
Mailing Address - Fax:240-420-8627
Practice Address - Street 1:1140 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5852
Practice Address - Country:US
Practice Address - Phone:240-420-8625
Practice Address - Fax:240-420-8627
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist