Provider Demographics
NPI:1326226499
Name:HARTY, ELIZABETH ANN (LIC DIPL AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:HARTY
Suffix:
Gender:F
Credentials:LIC DIPL AC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:RUBIN-HARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC DIPL AC
Mailing Address - Street 1:4108 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1817
Mailing Address - Country:US
Mailing Address - Phone:301-927-0504
Mailing Address - Fax:
Practice Address - Street 1:4108 28TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1817
Practice Address - Country:US
Practice Address - Phone:301-927-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist