Provider Demographics
NPI:1518098953
Name:ALLEN, REBECCA A (LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 BAILIFF RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-2151
Mailing Address - Country:US
Mailing Address - Phone:410-287-9110
Mailing Address - Fax:
Practice Address - Street 1:102B E CECIL AVE
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-4008
Practice Address - Country:US
Practice Address - Phone:410-287-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01412171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist