Provider Demographics
NPI:1558795013
Name:WALTER SCOTT MA, LAC
Entity Type:Organization
Organization Name:WALTER SCOTT MA, LAC
Other - Org Name:ACUPUNCTURE CENTER OF BALTIMORE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:443-904-0364
Mailing Address - Street 1:12282 BONMOT PL
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1739
Mailing Address - Country:US
Mailing Address - Phone:443-904-0364
Mailing Address - Fax:
Practice Address - Street 1:6 PARKS AVE
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4937
Practice Address - Country:US
Practice Address - Phone:443-904-0364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01697261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center