Provider Demographics
NPI:1619292638
Name:EASTERN LIGHT ORIENTAL MEDICINE, INC.
Entity Type:Organization
Organization Name:EASTERN LIGHT ORIENTAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:443-850-2733
Mailing Address - Street 1:404 6TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6828
Mailing Address - Country:US
Mailing Address - Phone:443-850-2733
Mailing Address - Fax:
Practice Address - Street 1:404 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6828
Practice Address - Country:US
Practice Address - Phone:443-850-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty