Provider Demographics
NPI:1316029135
Name:TEPPER, LAWRENCE JOSEPH (MS MAC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:TEPPER
Suffix:
Gender:M
Credentials:MS MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MONTEVUE LANE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8212
Mailing Address - Country:US
Mailing Address - Phone:301-471-4196
Mailing Address - Fax:301-662-8195
Practice Address - Street 1:286 MONTEVUE LANE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8212
Practice Address - Country:US
Practice Address - Phone:301-471-4196
Practice Address - Fax:301-662-8195
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBB10OtherCAREFIRST BLUE CROSS
MDG932OtherCAREFIRST BLUE CHOICE