Provider Demographics
NPI:1740421411
Name:STEWART, LILLIE ELLIOTTE (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:ELLIOTTE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NORTHFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2817
Mailing Address - Country:US
Mailing Address - Phone:443-955-0401
Mailing Address - Fax:
Practice Address - Street 1:307 NORTHFIELD PL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2817
Practice Address - Country:US
Practice Address - Phone:443-955-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist