Provider Demographics
NPI:1467588632
Name:STROMBERG, DEBORAH ANN (MAC LAC DIPLAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:MAC LAC DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5431
Mailing Address - Country:US
Mailing Address - Phone:301-891-3964
Mailing Address - Fax:
Practice Address - Street 1:6935 LAUREL AVE
Practice Address - Street 2:203
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4413
Practice Address - Country:US
Practice Address - Phone:301-270-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01212171100000X
DCAC500021171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist