Provider Demographics
NPI:1376916809
Name:GIFFORD, DAWN R (DOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:R
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 CATHELL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-9328
Mailing Address - Country:US
Mailing Address - Phone:410-725-9048
Mailing Address - Fax:410-630-5673
Practice Address - Street 1:11033 CATHELL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-9328
Practice Address - Country:US
Practice Address - Phone:410-725-9048
Practice Address - Fax:410-630-5673
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist