Provider Demographics
NPI:1730485566
Name:PADDOCK, KRISTAPS JG (ND)
Entity Type:Individual
Prefix:DR
First Name:KRISTAPS
Middle Name:JG
Last Name:PADDOCK
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4800 ROLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210
Mailing Address - Country:US
Mailing Address - Phone:443-835-1268
Mailing Address - Fax:844-654-7169
Practice Address - Street 1:4800 ROLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210
Practice Address - Country:US
Practice Address - Phone:443-835-1268
Practice Address - Fax:844-654-7169
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDJ0000002175F00000X
DCNP0027175F00000X
MDJ00002175F00000X
DCNP-0027175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath