Provider Demographics
NPI:1376739797
Name:SMITH, ERIC HENRY (MAC,LAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:HENRY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6258
Mailing Address - Country:US
Mailing Address - Phone:443-417-4821
Mailing Address - Fax:
Practice Address - Street 1:658 BOULTON ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4214
Practice Address - Country:US
Practice Address - Phone:410-836-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist