Provider Demographics
NPI:1619474715
Name:NEWHARDT, MAGDALENA (LAC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:NEWHARDT
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 1:2976 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9719
Mailing Address - Country:US
Mailing Address - Phone:410-610-8831
Mailing Address - Fax:
Practice Address - Street 1:1616 FOREST DR STE 4
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1019
Practice Address - Country:US
Practice Address - Phone:410-610-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02453OtherMARYLAND LICENSE