Provider Demographics
NPI:1679842579
Name:PASTORE, JAMES (MAC,LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PASTORE
Suffix:
Gender:M
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 PARKLAWN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2622
Mailing Address - Country:US
Mailing Address - Phone:202-669-8945
Mailing Address - Fax:
Practice Address - Street 1:4963 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7909
Practice Address - Country:US
Practice Address - Phone:301-986-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD808371171100000X
DCAC500148171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist