Provider Demographics
NPI:1285828004
Name:MEAD, ROBERTA (MAC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 OPOSSUMTOWN PIKE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4748
Mailing Address - Country:US
Mailing Address - Phone:301-695-9111
Mailing Address - Fax:301-695-9112
Practice Address - Street 1:1560 OPOSSUMTOWN PIKE
Practice Address - Street 2:SUITE 25
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4748
Practice Address - Country:US
Practice Address - Phone:301-695-9111
Practice Address - Fax:301-695-9112
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01482171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist