Provider Demographics
NPI:1629567292
Name:LEINER, ALISON (LAC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:LEINER
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 1:35214 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-4581
Mailing Address - Country:US
Mailing Address - Phone:443-844-7650
Mailing Address - Fax:
Practice Address - Street 1:29 BROAD ST STE 206
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1055
Practice Address - Country:US
Practice Address - Phone:443-844-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist