Provider Demographics
NPI:1639261019
Name:SHI, CHENGZHANG (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHENGZHANG
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3327 GOVERNOR MARTIN CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3458
Mailing Address - Country:US
Mailing Address - Phone:410-905-7140
Mailing Address - Fax:410-465-2310
Practice Address - Street 1:2 HAMILL RD
Practice Address - Street 2:STE 404
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1806
Practice Address - Country:US
Practice Address - Phone:410-905-7140
Practice Address - Fax:410-243-9714
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist