Provider Demographics
NPI:1346477965
Name:GRUDI, KARISA ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KARISA
Middle Name:ANN
Last Name:GRUDI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:707 YORK RD
Mailing Address - Street 2:APT. 5202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-275-2646
Mailing Address - Fax:443-275-2996
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:STE 310
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3331
Practice Address - Country:US
Practice Address - Phone:443-275-2646
Practice Address - Fax:443-275-2996
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01659-MD171100000X
MDU01659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist