Provider Demographics
NPI:1366008179
Name:BALTIMORE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BALTIMORE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAC
Authorized Official - Phone:443-254-6841
Mailing Address - Street 1:PO BOX 5364
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-0364
Mailing Address - Country:US
Mailing Address - Phone:443-254-6841
Mailing Address - Fax:
Practice Address - Street 1:1501 SULGRAVE AVE STE 310
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3654
Practice Address - Country:US
Practice Address - Phone:443-254-6841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center