Provider Demographics
NPI:1295366839
Name:GREINER, MARK FREDERICK (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FREDERICK
Last Name:GREINER
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 1:7603 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6446
Mailing Address - Country:US
Mailing Address - Phone:301-920-0226
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5336
Practice Address - Country:US
Practice Address - Phone:410-312-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02710171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty