Provider Demographics
NPI:1720409485
Name:WARREN, ELAINE (MAC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 NOYES DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2224
Mailing Address - Country:US
Mailing Address - Phone:301-351-1595
Mailing Address - Fax:301-565-3210
Practice Address - Street 1:11780 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2533
Practice Address - Country:US
Practice Address - Phone:301-351-1595
Practice Address - Fax:301-565-3210
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist